Cognard Type V Dural Arteriovenous Fistula: A Case Report

Authors

  • Vu Dang Luu Radiology Institute, Bach Mai Hospital, Hanoi/ Department of Radiology, Hanoi Medical University, Hanoi
  • Do Le Anh Trung Radiology Institute, Bach Mai Hospital, Hanoi
  • Tran Cuong Radiology Institute, Bach Mai Hospital, Hanoi
  • Nguyen Tat Thien Radiology Institute, Bach Mai Hospital, Hanoi
  • Vo Hong Quan Radiology Institute, Bach Mai Hospital, Hanoi
  • Nguyen Kim Tuyen Department of Radiology, Hanoi Medical University, Hanoi
  • Dinh Thi Phuong Dung Department of Radiology, Hanoi Medical University, Hanoi

DOI:

https://doi.org/10.3941/jrcr.6185

Abstract

Dural arteriovenous fistula with perimedullary venous drainage (Cognard type V) is a rare intracranial vascular lesion that may cause progressive myelopathy due to venous hypertension and is frequently misdiagnosed because of nonspecific clinical and magnetic resonance imaging (MRI) findings. We report an adult patient presenting with progressive neurological deficits at the cervicomedullary junction. MRI showed diffuse T2-Weighted hyperintensity and swelling without diffusion restriction; subtle perimedullary flow voids were initially overlooked. The patient received corticosteroids for presumed myelitis, with subsequent deterioration. Digital subtraction angiography revealed a dural arteriovenous fistula supplied by intracranial dural branches with perimedullary venous drainage. Owing to unfavorable anatomy for endovascular therapy, microsurgical disconnection was performed. Therefore, early recognition and angiographic confirmation are essential to avoid delayed diagnosis and irreversible neurological injury.

62-year-old male patient with Cognard type V dAVF: MRI findings at admission. (A), (B): Sagittal T2-Weighted (A) and STIR (B) images show a hyperintense lesion in the medulla oblongata and upper cervical spinal cord at C1-C2, with several small flow voids representing dilated vessels along the anterior surface of the medulla (large white arrows), which were initially overlooked. (C), (D): Axial FLAIR images show hyperintensity without diffusion restriction on DWI

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Published

2026-06-08

Issue

2026: Articles in Press

Section

Interventional Radiology

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