Figure 1: (a) Spinal MRI showed a serpiginous appearance of the spinal vessels with spinal edema which are in favor of SAVF. He had also a posterior intraspinal T2 hypersignal extended from D3 to L1, a sign of spinal cord ischemia. (b)Angiography confirmed the presence of epidural C6 to D3 AVF supplied by the right 4th intercostal artery

Figure 2: (a) The spinal cord MRI showed a serpiginous appearance of the lumbar vessels, a lumbar hypersignals and a terminal cone hypersignal. (b) Angiography confirmed the complete exclusion of the old fistula (Figure 2b1) and the presence of a 2nd dural fistula supplied by a radiculo-meningeal branch of the 1st left lumbar artery (Figure 2b2), not seen on the 1st angiogram