Enhanced cervical MRI in identifying intracranial dural arteriovenous fistulae with spinal perimedullary venous drainage

Chen, C. J.; Chen, C. M.; Lin, Tzu‐Chieh

doi:10.1007/s002340050609

Cited by 44 publications

(18 citation statements)

References 11 publications

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“…[2][3][4][6][7][8]10,[15][16][17][19][20][21][22][23][24][25][26][27][28][29][30] The most common symptom is ascending myelopathy, starting as loss of sensation and motor function in the lower extremities and extending to the upper extremities. Sphincter function is impaired.…”

Section: Discussionmentioning

confidence: 99%

Intracranial Dural Arteriovenous Fistula With Venous Reflux to the Brainstem and Spinal Cord Mimicking Brainstem Infarction-Case Report-

Ezura

Takahashi

et al. 2004

Neurol. Med. Chir.(Tokyo)

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A 73-year-old man presented with a rare transverse sinus dural arteriovenous fistula (dAVF) with venous reflux to the brainstem and medulla manifesting as brainstem and spinal cord edema mimicking brainstem infarction. Complete occlusion of the fistula was achieved by transvenous embolization, resulting in angiographic cure of the fistula and progressive improvement of the symptoms. Intracranial dAVFs with perimedullary venous drainage, type V according to the Cognard classification, are rare lesions with distinctive clinical, radiological, and therapeutic aspects. This case demonstrates that the symptoms of dAVF with perimedullary venous reflux are variable, so dAVF should be considered in patients with clinical and radiological findings suggestive of congestion in the brainstem and spinal cord. Dysfunction of the medulla and spinal cord caused by venous hypertension is the most probable cause of the neurological symptoms in such cases. Interventional therapy can lead to angiographic cure and resolution of the symptoms.

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Section: Discussionmentioning

confidence: 99%

Intracranial Dural Arteriovenous Fistula With Venous Reflux to the Brainstem and Spinal Cord Mimicking Brainstem Infarction-Case Report-

Ezura

Takahashi

et al. 2004

Neurol. Med. Chir.(Tokyo)

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“…Following contrast administration, diffuse enhancement may be seen within the cord as a sign of chronic venous congestion with a breakdown of the bloodϪspinal cord barrier (Fig 4). 49,50 SDAVFs may occur anywhere from the level of the foramen magnum to the sacrum and localization of these lesions may be difficult and challenging, especially in cases in which cord edema occurs distant from the AV shunt location. 51 Thus, the noninvasive evaluation of the shunt location is extremely helpful to guide the invasive conventional angiography.…”

Section: Clinical Featuresmentioning

confidence: 99%

Spinal Dural Arteriovenous Fistulas

Krings¹,

Geibprasert²

2009

AJNR Am J Neuroradiol

358

376

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SUMMARY:Spinal dural arteriovenous (AV) fistulas are the most commonly encountered vascular malformation of the spinal cord and a treatable cause for progressive para-or tetraplegia. They most commonly affect elderly men and are classically found in the thoracolumbar region. The AV shunt is located inside the dura mater close to the spinal nerve root where the arterial blood from a radiculomeningeal artery enters a radicular vein. The increase in spinal venous pressure leads to decreased drainage of normal spinal veins, venous congestion, and the clinical findings of progressive myelopathy. On MR imaging, the combination of cord edema, perimedullary dilated vessels, and cord enhancement is characteristic. Therapy has to be aimed at occluding the shunting zone, either by superselective embolization with a liquid embolic agent or by a neurosurgical approach. Following occlusion of the fistula, the progression of the disease can be stopped and improvement of symptoms is typically observed. Despite being the most commonly encountered spinal vascular malformation, spinal dural arteriovenous fistulas (SDAVFs) are rare and still underdiagnosed entities, which, if not treated properly, can lead to considerable morbidity with progressive spinal cord symptoms. Because presenting clinical symptoms are unspecific, the neuroradiologist is often the first clinician to raise the possibility of this diagnosis, which initially rests mainly on MR imaging. For a thorough understanding of the disease and for planning the therapeutic strategy, however, selective spinal digital subtraction angiography (DSA) still is necessary. The aim of the following article is to review the epidemiology, etiology, clinical and imaging features, and therapeutic approaches of this type of spinal vascular malformation. Because an understanding of spinal vascular malformations both from an etiologic and pathophysiologic standpoint is based on the spinal vascular anatomy, we will start by briefly describing the salient features of the spine and spinal cord arterial supply and venous drainage followed by a classification of spinal vascular malformations in general and a classification of dural arteriovenous (AV) shunts in particular. Embryology and Anatomy of the Spinal VasculatureDevelopment of the neural plate starts during the third gestational week and is derived from the embryologic ectoderm. This process is induced by the underlying notochord and adjacent mesoderm, which regulate the development of the surrounding structures, including the nerves, blood vessels, and somites.1 In this stage, the angioblasts initially form small cell clusters (blood islands) within the embryonic and extraembryonic mesoderm.2 Formation of the neural tube begins early in the fourth week (days 22-23) with closure of the rostral and caudal neuropore during days 25-27, which coincides with the establishment of the intrinsic blood vascular circulation within the spinal cord.3 Two longitudinal collector systems form in the subarachnoid space at the dorsal and ventral surfac...

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“…Congestive myelopathy was suspected based on clinical examination and MRI demonstrating enlargement of the spinal cord with central confluent, focal, or extensive T2 hyperintensity over multiple segments, with or without patchy contrast enhancement. 14,15 Spinal catheter angiography with complete evaluation of all possible feeding arteries was performed in all patients, and a confirmative diagnosis was made on the basis of spinal angiograms. Angioarchitecture, locations, and types of the vascular malformation were evaluated by spinal angiography.…”

Section: Radiological Evaluationmentioning

confidence: 99%

Clinical Features and Outcomes of Spinal Cord Arteriovenous Malformations

Lee

terBrugge

Saliou

et al. 2014

Stroke

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Background and Purpose-As a result of the rarity of spinal cord arteriovenous malformations (AVM), there are only a few series available that describe clinical features, outcome after treatment, and natural history of these lesions. In this article, we aim to describe our experience with both nidus-and fistulous-type spinal cord AVMs. Methods-Forty-four consecutive patients with spinal cord AVMs were retrospectively reviewed. There were 26 patients with a nidus-type and 18 patients with a fistulous-type AVM. Treatments were performed with embolization (n=23), surgery (n=13), combined embolization-surgery (n=3), or conservative management (n=5). Clinical features, radiological findings, treatment results, and clinical outcomes were assessed. Results-Patients with nidus-type AVMs were younger at presentation and more often presented with hemorrhage, with a higher proportion of hematomyelia than fistulous-type AVMs (P<0.05). Progression of clinical presentation from hemorrhage to congestive myelopathy during follow-up was noted in 5 patients, all of which had AVMs of the nidus type. Complete obliteration could be achieved more often in the fistulous type (72%) than in the nidus type (27%). Improved or stable clinical status at last follow-up was noted in 100% of fistulous-type and 77% of nidus-type patients. Long-term clinical deterioration was noted in 6 of 26 patients with nidus-type (23%) AVMs and was related to recurrent bleeding (n=3) or progressive venous congestion (n=3). Overall rebleed rate after presentation with hemorrhage was 7 in 145.5 patient-years (4.8%/y) if the lesion was not treated, 3 in 102 patient-years (2.9%/y) after partial treatment, and 0 in 47.5 patient-years (0%) after complete treatment. Conclusions-Nidus

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Enhanced cervical MRI in identifying intracranial dural arteriovenous fistulae with spinal perimedullary venous drainage

Cited by 44 publications

References 11 publications

Intracranial Dural Arteriovenous Fistula With Venous Reflux to the Brainstem and Spinal Cord Mimicking Brainstem Infarction-Case Report-

Intracranial Dural Arteriovenous Fistula With Venous Reflux to the Brainstem and Spinal Cord Mimicking Brainstem Infarction-Case Report-

Spinal Dural Arteriovenous Fistulas

Clinical Features and Outcomes of Spinal Cord Arteriovenous Malformations

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