Dural AVF at the foramen magnum with perimedullary

perimedullary venous drainage is known to cause slowly progressive ascending myelopathy involving first the lower limbs and then the upper limbs. Often sphincter disturbances are present (1, 2). Even though it cannot provide precise location of fistula, MRI appearance is virtually pathognomonic. A swollen cord with central myelopathy and engorged perimedullary veins are indicative of the diagnosis of a fistula, either cervical spinal dural AVF or an intracranial dural AVF with perimedullary venous drainage (3). The case of this study had typical but rare symptoms and imaging findings, so that a correct diagnosis was delayed to irreversible cord injury. Little improvement was expected despite curative embolization of the fistula in this patient.