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A 79-year-old man presented with a 2-month history of falls, urinary retention, and constipation. Examination revealed spastic paraparesis and T3 sensory level. Magnetic resonance imaging (Figure 1A) and angiography (Figure 1B and C) revealed a type I spinal dural arteriovenous fistula (sDAVF) at the left C1 nerve root with feeders from the vertebral artery and caudal drainage through the coronal perispinal venous plexus. Following clip ligation of the sDAVF (Figure 2), magnetic resonance imaging (Figure 1D) demonstrated resolution of dilated vessels and the patient showed improved motor strength and incontinence. Upper cervical sDVAFs make up only 2% of sDAVFs1 and can present with lower-level cord symptoms.
Tipirneni A, Haussen DC, Morcos JJ, Yavagal DR. Paraparesis From Upper Cervical Spinal Dural Arteriovenous Fistula. JAMA Neurol. 2015;72(8):936-937. doi:10.1001/jamaneurol.2015.0864