부산대학교 도서관

A 69-year-old man developed intractable hiccups followed by gait disturbance and dysuria. MRI showed a medullary lesion including the area postrema and gadolinium-enhanced MRI did not show any abnormal blood vessels. Neuromyelitis optica spectrum disorder (NMOSD) was considered, but serum aquaporin-4 autoantibody was negative. 3D-CT angiography (CTA) showed an abnormal blood vessel at the dural penetration site of the right vertebral artery and 4D-CTA revealed abnormal shunt circulation dynamically, indicating a diagnosis of Cranio-cervical junction dural arteriovenous fistula (CCJDAVF). After microsurgical clipping of the draining vein, the symptoms were improved and the medullary lesion became smaller. Because steroid therapy may exacerbate the condition in CCJDAVF, unlike in NMOSD, it is important to examine with CTA, even if abnormal blood vessels are not detected with MRI. In particular, hemodynamic evaluation with 4D-CTA is useful for the diagnosis of CCJDAVF.