Emphasisethat dural arteriovenous fistulas (DAVF) are an important differential when considering causes for long segment cervical cord signal abnormality. Recap neurovascular anatomy. Identify tips and tricks usedto diagnosecervicalDAVF by exploring5 cases. Visitendovascular treatment options.

Cervical myelopathy secondary to DAVF is a rare but treatable entity. Symptoms are usually progressive in nature eventually resulting in devastating paresis.MRI can sometimes only show cord signal abnormality, as traditional findings in thoracolumbar DAVFs (e.g. engorged perimedullary vessels) may be absent, subtle or unusual.Diagnosis is often missed and other conditions such as transverse myelitis, neoplasm or infarction are considered. Early treatment offers good patient outcomes. In almost all of the 5 cases we describe, DAVF was not considered at the point of secondary care;diagnosis...

SYMPTOMOLOGY DAVF present insidiouslywith progressive weakness, gait disturbance and paraesthasia. Subarachnoidhaemorrhage is rare but has been observed.Back pain is usually not a feature. PATHOGENESIS DAVFs arising at the level of the cervical cord, the craniocervical junction or skull base can cause myelopathy. In contrast to thoracolumbar DAVFs, where the feeder usually comes from radiculomedullary arteries(RMA), from our experience feeders tend to be extraspinal, involving cranial vessels.The aetiology remains the same; arterialisation of draining veins resulting in venous hypertension, ischaemia and myelopathy. Dilated, tortuoues veins can...

DAVF is often overlooked as a causeof cervical myelopathyand thiscan leadto significant morbidity if left untreated. The tips and tricks we use which enable use to quickly diagnose cervical DAVF are highlighted inFig. 24.

A.J.Bleakley;Liverpool/UK-nothing-to-disclose. M.Puthuran;Liverpool/UK-nothing-to-disclose. S.Biswas;Liverpool/UK-nothing-to-disclose. O.Babatola;Liverpool/UK-nothing-to-disclose. R.Pullicino;Liverpool/UK-nothing-to-disclose. S.Masri;Liverpool/UK-nothing-to-disclose. A.Chandran;Liverpool/UK-nothing-to-disclose. M. Bhojak;Liverpool/UK-nothing-to-disclose.

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