Positional vomiting due to a thoracic spinal dural arteriovenous fistula. Case report

The authors report the unique case of a patient with a thoracic spinal dural arteriovenous fistula (DAVF) causing remote brainstem symptoms of positional vomiting and minimal vertigo. Magnetic resonance (MR) imaging of the brain demonstrated high signal abnormality in the medulla, presumably related...

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Bibliographic Details
Published inJournal of neurosurgery. Spine Vol. 1; no. 2; p. 219
Main Authors Cordato, Dennis J, Davies, Mark A, Masters, Lynette T, Cremer, Phillp D, Schwartz, Raymond S, Sorby, William, Becvarovski, Zoran
Format Journal Article
LanguageEnglish
Published United States 01.09.2004
Subjects
Angiography
Arteriovenous Fistula - complications
Dura Mater - blood supply
Follow-Up Studies
Humans
Magnetic Resonance Imaging
Male
Medulla Oblongata - blood supply
Middle Aged
Posture
Thoracic Vertebrae - blood supply
Venous Pressure - physiology
Vertigo - etiology
Vomiting - etiology
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Summary:The authors report the unique case of a patient with a thoracic spinal dural arteriovenous fistula (DAVF) causing remote brainstem symptoms of positional vomiting and minimal vertigo. Magnetic resonance (MR) imaging of the brain demonstrated high signal abnormality in the medulla, presumably related to venous hypertension, and spinal MR imaging revealed markedly dilated veins along the dorsal aspect of the cord. Spinal angiography confirmed the presence of a thoracic spinal DAVF. Disconnection of the DAVF from the spine resulted in a marked improvement in symptoms and resolution of the preoperative MR imaging-documented abnormalities. The authors highlight the rare syndrome of positional vomiting as a brainstem symptom and conclude that spinal DAVFs should be considered in the differential diagnosis of high signal MR imaging abnormalities localized to the brainstem.
ISSN:1547-5654
DOI:10.3171/spi.2004.1.2.0219