Clinical Outcomes of Patients with Delayed Diagnosis of Spinal Dural Arteriovenous Fistulas

Brinjikji, Waleed; Nasr, Deena M.; Morris, Jonathan M.; Rabinstein, Alejandro A.; Lanzino, Giuseppe

doi:10.3174/ajnr.a4504

Cited by 61 publications

(64 citation statements)

References 21 publications

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“…First, the imaging characteristics of SEDAVFs on MRI are very similar to those of SDAVFs, with a vast majority of patients presenting with high T2 cord signal intensity, intradural vascular flow voids, and spinal cord enhancement. 2 However, especially in the sacral fistulas, it is not unusual that the only exuberant intradural flow void noted is a large, arterialized vein ascending from the sacrum to the conus ( Fig. 3).…”

Section: Imaging Characteristicsmentioning

confidence: 98%

Clinical presentation and treatment outcomes of spinal epidural arteriovenous fistulas

Nasr¹,

Brinjikji

Clarke

et al. 2017

Journal of Neurosurgery: Spine

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OBJECTIVESpinal epidural arteriovenous fistulas (SEDAVFs) constitute a rare but treatable cause of vascular myelopathy and are a different subtype from the more common Type I spinal dural AVFs. The purpose of this study was to review a consecutive series of SEDAVFs from a single institution and report on the clinical presentations, functional status, and treatment outcomes.METHODSThe authors identified all SEDAVFs treated at their institution from 2005 to 2015. SEDAVFs were defined as spinal AVFs in which the fistulous connection occurred in the epidural venous plexus. The clinical presentation, functional status, immediate treatment outcomes, and long-term neurological outcomes were analyzed.RESULTSTwenty-four patients with SEDAVFs were included in this study. The patients' mean age at presentation was 66.9 years. The most common presenting symptoms were pain and numbness (22 patients, 91.7%), followed by lower-extremity weakness (21 patients, 87.5%). The mean duration of symptoms prior to diagnosis was 11.8 months. Eighteen patients (75.0%) were treated with endovascular therapy alone, 4 (16.7) with surgery, and 2 (8.3%) with a combination of techniques. There was 1 major treatment-related complication (4.2%). Fifteen patients (62.5%) had improvement in disability, and 12 patients (54.5%) had improvement in sensory symptoms.CONCLUSIONSSEDAVFs often present with lower-extremity motor dysfunction and sensory symptoms. With the availability of newer liquid embolic agents, these lesions can be effectively treated with endovascular techniques. Surgery is also effective at treating these lesions, especially in situations where endovascular embolization fails or is not safe and in patients presenting with mass effect from compressive varices.

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Section: Imaging Characteristicsmentioning

confidence: 98%

Clinical presentation and treatment outcomes of spinal epidural arteriovenous fistulas

Nasr¹,

Brinjikji

Clarke

et al. 2017

Journal of Neurosurgery: Spine

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show abstract

“…Because of the non-specific nature of the presenting symptoms and slow onset, SAVFs often go clinically undiagnosed or are misdiagnosed as peripheral neuropathy, spinal stenosis, multiple sclerosis, transverse myelitis, or radiculopathies 2 3. Misdiagnosed patients are often treated with immunosuppressants, immunomodulating agents, and decompressive surgeries which can sometimes result in additional morbidity 2…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes following corticosteroid administration in patients with delayed diagnosis of spinal arteriovenous fistulas

Nasr

Brinjikji

Rabinstein

et al. 2016

J NeuroIntervent Surg

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“…It occurs when the arteries supplying the nerve roots or dura mater communicate with the spinal drainage vein when passing through the dura mater at the intervertebral foramen. Because the incidence of SDAVF is extremely low and the clinical manifestations are not typical [5], early diagnosis is not easy, and the misdiagnosis rate is high [6,7]. If diagnosis and treatment are delayed, spinal venous pressure continues to increase and can cause spinal cord ischemia and edema and even irreversible injuries, such as necrosis and demyelination.…”

Section: Discussionmentioning

confidence: 99%

Misdiagnosis of Spinal Dural Arteriovenous Fistula: An Analysis of 12 Cases

Yang

Cao

et al. 2020

Preprint

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Background: Spinal dural arteriovenous fistula (SDAVF) is a rare spinal vascular disease. The clinical misdiagnosis rate is very high. The highest misdiagnosis rate is reported in orthopedics. The specific reason for misdiagnosis remains unclear. Objective: To investigate the clinical and imaging manifestations of SDAVF, analyze the causes of misdiagnosis, propose countermeasures, and improve the orthopedists and other specialists’ understanding of this disease. Methods: The clinical data, diagnosis and treatment of 12 patients who had SDAVF that was misdiagnosed as a different disease were retrospectively analyzed, and the modified Aminoff-Logue Disability Scale (ALS) scores before and during follow-up were compared. Results: From 2014 to February 2019, 15 patients were diagnosed with SDAVF at our institution. Twelve (80%) were misdiagnosed; of these, 6 (50%) were misdiagnosed more than twice, and 6 patients (50%) were misdiagnosed at least once. The initial diagnoses included lumbar spinal stenosis and lumbar disc herniation (LDH) in 6 patients, cervical spinal stenosis in one patient, benign prostatic hyperplasia (BPH) in one patient, myelitis in 2 patients, and syringomyelia in one patient. After the initial diagnosis, one patient was misdiagnosed with LDH, one was misdiagnosed with subacute combined degeneration of the spinal cord, and 4 were misdiagnosed with myelitis. The clinical manifestations mainly included weakness and numbness of the lower limbs, urinary symptoms, and numbness of the perineal area. In the 12 misdiagnosed patients, magnetic resonance imaging(MRI) showed signs of spinal cord edema and typical or atypical flow-void patterns. One patient had undergone extended cervical decompression and lumbar decompression. All patients eventually underwent microsurgical treatment. The average follow-up duration was 0.9 years. The modified ALS scores showed significant improvement in gait, bladder function and bowel movement, and the differences before and during follow-up were statistically significant (P<0.05). Conclusion: When patients, especially those with bladder and bowel dysfunction, have symptoms such as weakness of the lower limbs and/or numbness, a diagnosis of SDAVF should be considered. Furthermore, if MRI shows signs of spinal cord edema and typical or atypical flow-void patterns, the diagnosis of SDAVF should be strongly considered, and further angiography is needed to confirm the diagnosis.

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Clinical Outcomes of Patients with Delayed Diagnosis of Spinal Dural Arteriovenous Fistulas

Cited by 61 publications

References 21 publications

Clinical presentation and treatment outcomes of spinal epidural arteriovenous fistulas

Clinical presentation and treatment outcomes of spinal epidural arteriovenous fistulas

Clinical outcomes following corticosteroid administration in patients with delayed diagnosis of spinal arteriovenous fistulas

Misdiagnosis of Spinal Dural Arteriovenous Fistula: An Analysis of 12 Cases

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