Dural arteriovenous fistula (DAVF) is mostly an acquired vascular lesion, either spontaneous, as in this case, or traumatic in origin. Dural arteriovenous fistulae at the craniocervical junction are very unusual, especially spontaneous ones without history of previous recent or old trauma.

Symptoms of DAVF of such localization may vary:

• most frequent course is gradually developing neurologic focal deficit depending on localization, which is related to venous congestion and subsequent development of subacute necrotizing encephalomyelopathy
• sometimes, signs of intracranial hypertension
• radiculopathy
• cranial nervу palsies
• subarachnoid hemorrhage is also a complication of DAVF, may be seen in approximately 45% cases
• occipitalgia
• transient ischemic attack

Median age of presentation of cervical DAVFs is believed to be 58 years and there is male predominance from 2:1 to 3:1 ³.

Magnetic resonance imaging is strongly indicated in cases of upper cervical myelopathy, either alone or with bulbar symptoms. Visual signs of edema of involved segments of the spinal cord and brainstem, high ADC, indicating vasogenic edema and excluding ischemic lesion, absence of contrast enhancement, excluding mass lesions, enlarged and tortuous subarachnoid vessels are strongly indicative of DAVF and selective DSA should be performed to confirm DAVF and consider its percutaneous embolization.