PMC8383207_01
Initial CT head showed subarachnoid haemorrhage (SAH) present in the frontal horn of the left lateral ventricle, third ventricle and fourth ventricle, and the foramen magnum; yellow arrows indicate blood component in the scans.
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F1
A head CT was performed on arrival (level I evidence), which showed acute subarachnoid blood predominantly perimesencephalic in distribution with extension into the ventricular system (Figure 1).
The left panels show the finding of the C2-3 dural arteriovenous fistula (AVF) in routine MRI head, highlighted within the red box. The middle and right panels show the digital subtraction angiography (DSA) cervical spine and the angio-CT of L-VA. The yellow arrows indicate the two supplying arteries; and the red boxes indicate tortuous venous drainage of the AVF.
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F2
However, there was a find of a small rounded lesion with enhancement at the level of C2-3, anterior to the cervical cord (Figure 2, left panels). It was a small 3-4-mm dilated varix in the midline and ventral to the cervical spinal cord, likely on the venous side, which is likely to represent the site of a recent haemorrhage (Figure 2, middle and right panels).
Follow-up spinal digital subtraction angiography (DSA) demonstrated images of L-VA; the yellow arrows indicate that the two supplying arteries no longer feed into the arteriovenous fistula (AVF); and red box indicates that tortuous venous drainage of the AVF had disappeared as compared with pre-op DSA image.
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F3
The result showed that the C2-3 no longer demonstrated dural AVF, and no further arteriovenous shunting presented (Figure 3).
A diagram of timeline for this case.
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F4