Teaching NeuroImages: MRI Abnormalities of Spinal Dural Arteriovenous Fistula in the Absence of Flow Voids

A 66-year-old woman presented with progressive spastic paraplegia and lumbar pain. Physical examination revealed hyperreflexia in lower extremities, reduced pinprick and vibration up to D12, and impaired hallux proprioception. Spinal MRI revealed multilevel centromedullary T2 hyperintensity and diffuse contrast enhancement except for abrupt intralesional segment (missing piece; figure 1).

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