Materiały źródłowe

• #1 Dural arteriovenous fistulas | Health Library | Memorial Health System

  https://www.mhsystem.org/health-library/con-20309677/

  Dural arteriovenous fistulas (dAVFs) are irregular connections between arteries and veins. They occur in the tough covering over the brain or spinal cord, known as the dura mater. The irregular passageways between arteries and veins are called arteriovenous fistulas, which can lead to bleeding in the brain or other serious symptoms. […] Some people with dural arteriovenous fistulas (dAVFs) may not have symptoms. When symptoms occur, they may be characterized as benign or aggressive. An aggressive dAVF has more-serious symptoms. […] Aggressive dAVF symptoms can result from bleeding in the brain, known as intracerebral hemorrhage. Bleeding in the brain often causes a sudden headache. It also may cause other symptoms based on the location and size of the hemorrhage. […] Aggressive symptoms also may result from nonhemorrhagic neurological deficits (NHNDs), which can include seizures or changes in mental abilities. These symptoms usually develop more gradually, over days to weeks. Symptoms are typically related to the area of the brain affected.

• #2 Dural Arteriovenous Fistula (DAVF) | Boston Medical Center

  https://www.bmc.org/patient-care/conditions-we-treat/db/dural-arteriovenous-fistula-davf

  Dural arteriovenous fistulas (DAVF) are abnormal connections between arteries and veins near the brain. […] These are acquired lesions that occur most commonly without an obvious cause, but can be associated with trauma, surgery, tumors, or previous infections near the area of the lesion. […] While dural arteriovenous fistulas are lesions outside the brain, they may present with a wide range of neurologic symptoms. […] The presentation varies from an asymptomatic state, to ringing or humming in the ear (or pulsatile tinnitus) to life-threatening or fatal bleeding in the brain. […] In benign fistulas, drainage does not involve the cerebral veins, and tinnitus or eye symptoms are often the most common forms of presentation. […] So-called „aggressive” or „dangerous” fistulas are characterized by retrograde cortical venous drainage, and present with bleeding in the brain, progressive neurological deficit, seizures, or intracranial hypertension.

• #3 Dural Arteriovenous Fistula – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK532274/

  Dural arteriovenous fistulas, sometimes referred to as dural arteriovenous malformations, are vascular abnormalities in which arteries arising from branches of the carotid or vertebral arteries drain directly into the dural leaflets of the venous sinuses. […] The clinical behavior of dAVFs, including the risk of intracranial hypertension and hemorrhage, predominantly depends on the venous drainage patterns. […] Some people with a dAVF may not have any symptoms and they are discovered during brain neuroimaging studies in the workup for other conditions. Some dAVFs can remain asymptomatic for a long period of time or even involute spontaneously. […] Those with symptoms can be characterized either as aggressive or benign and can include any or a combination of the following symptoms: Headache, Nausea/vomiting, Seizures, Cranial neuropathies, Pulsatile tinnitus (bruits), Intracranial hypertension, Papilledema, Glaucoma, Hydrocephalus, Intracerebral hemorrhage, Speech or language issues, Coordination issues, Altered sensations, Weakness, Face pain, Dementia, Parkinsonism, Apathy, Vision problems, Proptosis.

• #4 Journal of Cerebrovascular and Endovascular Neurosurgery

  https://www.the-jcen.org/m/journal/view.php?number=12

  A dural arteriovenous fistula (DAVF) generally refers to a vascular malformation of the wall of a major venous sinus. These lesions have diverse symptoms according to the location and venous drainage, and require multidisciplinary treatment. […] Patients may be asymptomatic or may experience symptoms ranging from mild to aggressive, according to lesion location and pattern of venous drainage. […] The risk of hemorrhage and aggressive symptoms in DAVF with CVR (Borden type II and III) was 23% and 41%. More significant development of hemorrhage and aggressive symptoms was observed in DAVFs with CVR (Borden type II and III). […] The clinical characteristics of intracranial DAVF depend on the lesion location and venous drainage pattern. In our study, the hemorrhagic risk associated with intracranial DAVFs increased according to the severity of CVR, and the transverse-sigmoid sinus is the location that most affects intracranial hemorrhage.

• #5 Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR): rationale, design, and initial characterization of patient cohort in: Journal of Neurosurgery Volume 136 Issue 4 (2021) Journals

  https://thejns.org/view/journals/j-neurosurg/136/4/article-p951.xml

  Cranial dural arteriovenous fistulas (dAVFs) are rare lesions, hampering efforts to understand them and improve their care. Overall, 852 patients (79%) presented with fistula-related symptoms: 427 (40%) presented with nonaggressive symptoms such as tinnitus or orbital phenomena, 258 (24%) presented with intracranial hemorrhage, and 167 (16%) presented with nonhemorrhagic neurological deficits. A smaller proportion (224 patients, 21%), whose dAVFs were discovered incidentally, were asymptomatic. Many patients (85%, 911/1077) underwent treatment via endovascular embolization (55%, 587/1077), surgery (10%, 103/1077), radiosurgery (3%, 36/1077), or multimodal therapy (17%, 184/1077). The median time from diagnosis to follow-up was 380 days (IQR 1201038.5 days). […] In total, 39% (425/1077) of patients presented with aggressive symptoms of hemorrhage or NHND: 24% (258/1077) with ICH attributable to the dAVF and 16% (167/1077) with NHNDs related to the dAVF. Most patients (60%, 651/1077) presented incidentally or with benign flow-related symptoms, including 40% (427/1077) with flow-related symptoms and 21% (224/1077) who were asymptomatic from the dAVF with incidental discovery.

• #6 Dural arteriovenous fistulas | Health Library | Memorial Health System

  https://www.mhsystem.org/health-library/con-20309677/

  Aggressive symptoms can include: Sudden headache. Trouble walking and falls. Seizures. Speech or language issues. Facial pain. Dementia. Slowed movement, stiffness and tremor, known as parkinsonism. Trouble with coordination. Burning or prickling sensations. Weakness. Lack of interest, known as apathy. Failure to thrive. Symptoms related to increased pressure, such as headaches, nausea and vomiting. […] Other dAVF symptoms can include hearing issues. People with hearing symptoms may hear a rhythmic sound in the ear that occurs with the heartbeat, known as pulsatile tinnitus. Symptoms also may include trouble with vision, such as: Vision changes. Eye bulge. Swelling in the eye lining. Paralysis of a muscle in or around the eye. […] Rarely, dementia may occur due to increased pressure in the blood vessels in the brain.

• #7 Dural Arteriovenous Fistula (dAVF): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/dural-arteriovenous-fistula-davf

  Some dural arteriovenous fistulas are mild and wont cause a major health complication, while others are very serious and can be life-threatening. If a vessel breaks and bleeding occurs, it can damage brain tissue and cause a stroke. […] You might not have symptoms if you have a dural arteriovenous fistula (dAVF). If you do, symptoms range from mild to severe and may vary based on the location of the fistula. Symptoms may include: Headache. Nausea and vomiting. Hearing a constant noise (pulsatile tinnitus). Vision changes. Speech or language difficulties. Trouble with balance and coordination. Muscle weakness or numbness. Pain in your face, arms or legs. Memory loss. Abnormal feelings or sensations. Symptoms are usually the result of bleeding within your brain. Contact a healthcare provider right away if you experience these symptoms.

• #8 Dural Arteriovenous Fistula Diagnosis & Treatment – NYC | Columbia Neurosurgery in New York City

  https://www.neurosurgery.columbia.edu/patient-care/conditions/dural-arteriovenous-fistula

  Patients with dural arteriovenous fistulas typically experience a bruit, a rumbling noise in one ear that follows the heartbeat. […] Other symptoms of dural AVFs include headache, ringing in the ears, visual problems, stroke-like symptoms, and rarely, dementia-like symptoms. […] Dural AVFs may hemorrhagea medical emergency. Symptoms of hemorrhage may include severe headache, sudden confusion, and sudden weakness or numbness (especially on only one side of the body).

• #9 Dural Arteriovenous Fistula – Symptoms and Treatment | Neuroaxis

  https://neuroaxis.com.au/conditions-treated/cerebrovascular-diseases/dural-av-fistulas/

  Most people diagnosed with DAVF may not have any symptoms. In some cases, symptoms of DAVF can be categorised either as benign or aggressive: […] The patient may experience hearing issues and vision problems. Vision problems can include eye bulge, visual deterioration, swelling in the eye lining, cavernous sinus syndrome, and eye-related palsies. There may be some cases of progressive dementia due to venous hypertension also. […] Such aggressive symptoms can occur either due to intracerebral haemorrhage (bleeding in the brain) or due to some neurological effects of non-haemorrhaging neurological deficits (NHNDs). […] Bleeding in the brain further leads to sudden headaches along with varying levels of neurological disability depending upon the location and size of the haemorrhage. […] Some of the following are the neurological symptoms associated with DAVF of the brain: Bruit (sound heard due to unusual blood flow), Pulsatile tinnitus (ringing in the ears), Visual difficulty, Headache, Seizures.

• #10 Dural arteriovenous fistula masquerading as pulsatile tinnitus: radiologic assessment and clinical implications | Scientific Reports

  https://www.nature.com/articles/srep36601

  Pulsatile tinnitus (PT) is often an initial presenting symptom of dural arteriovenous fistula (dAVF), but it may be overlooked or diagnosed late if not suspected on initial diagnostic work-up. […] Of 220 patients who were diagnosed with dAVF between 2003 and 2014, 30 (13.6%) presented with only PT as their initial symptom. […] PT disappeared completely in 21 (80.8%) of 26 patients who underwent therapeutic intervention with transarterial embolization of the fistula, improved markedly in 3 (11.5%), and remained the same in 2 (7.7%). […] In conclusion, considering that PT may be the only initial symptom in more than 10% of dAVF, not only otolaryngologists but also neurologists and neurosurgeons should meticulously evaluate patients with PT. […] In most cases, PT originating from dAVF can be cured with transarterial embolization regardless of location and venous drainage pattern.

• #11 Dural Arteriovenous Fistula (AVF) | University of Michigan Health

  https://www.uofmhealth.org/radiology-and-imaging/neurointerventional-radiology/dural-arteriovenous-fistula

  Location of the dural AVF is one of the key elements to a frequently observed symptom, i.e. whooshing or heartbeat noise that can be constantly or intermittently heard, usually in one ear. […] A class 1 fistula has a low risk of bleeding but can have significant disability. Usual disabilities include frequent severe headaches or continual whooshing sound in the ear. Some patients are able to deal with these symptoms but others cannot. Patients who have significant disability can choose to have their fistula treated. Class 2 and 3 fistulas represent a significant risk to a patient from intracranial bleeding. These fistulas should be treated promptly.

• #12 Journal of Cerebrovascular and Endovascular Neurosurgery

  https://www.the-jcen.org/m/journal/view.php?number=12

  Aggressive neurological symptoms correlated well with the venous drainage pattern of transverse-sigmoid sinus DAVFs because these occurred only in Borden type II and III. […] In our study, 6% of Borden type I, 31% of Borden type II, and 77% of Borden type III DAVFs presented with aggressive symptoms including intracranial hemorrhage. Therefore, aggressive neurologic symptoms showed strong correlation with CVR. […] In this study, the most common symptoms of cavernous sinus DAVF were ocular symptoms (40%) and aggressive neurologic symptoms were rare; there was no occurrence of intracranial hemorrhage. […] The majority of patients with DAVFs presented with non-aggressive symptoms. Thirty six patients (38%) had pulsatile tinnitus and bruit, 15 patients (16%) had ocular and visual symptoms, 12 patients (13%) had mild to moderate headache, and five patients (5%) were found incidentally. Twenty seven patients (28%) presented with aggressive symptoms. Fifteen patients (16%) had intracranial hemorrhage, nine patients (9%) had seizure, and three patients (3%) had dementia, trigeminal neuralgia, and aphasia. […] The clinical outcome of DAVFs was excellent in 80 patients (84%).

• #13 Dural arteriovenous fistulas

  https://www.mymlc.com/health-information/diseases-and-conditions/d/dural-arteriovenous-fistulas/?section=Treatment

  Some people with a dAVF may not have any symptoms. However, apparent symptoms can be characterized either as aggressive or benign. […] Aggressive dAVF symptoms can result either from bleeding in the brain (intracerebral hemorrhage) or from neurological effects of non-hemorrhaging neurological deficits (NHNDs). […] Bleeding in the brain often causes sudden onset of a headache with varying degrees of neurological disability related to the location and size of the hemorrhage. […] By contrast, an NHND usually develops more gradually, over days to weeks, and typically produces a set of symptoms related to its location. These aggressive symptoms can include seizures, speech or language issues, face pain, dementia, Parkinsonism, coordination issues, burning or prickling sensations, weakness, apathy, failure to thrive, and symptoms related to increased pressure such as headaches, nausea and vomiting.

• #14 Dural Arteriovenous Fistula Symptoms | Expert Surgeon | Aaron Cohen-Gadol, MD

  https://www.aaroncohen-gadol.com/en/patients/arteriovenous-fistula/types/symptoms

  Dural AVFs are of particular significance because they can cause several health issues. The symptoms associated with dAVF encompass headaches, nausea, vomiting, seizures, speech or language difficulties, dementia, instability, visual deterioration, and protrusion of the eyes. […] Common symptoms include: Pulsatile Tinnitus: A whooshing sound in the ear that matches the rhythm of your heartbeat. Headache: Often feels like a constant, localized pain. Neurological Deficits: This can include weakness, numbness, or other specific problems related to nerve function. Visual Disturbances: This might involve vision loss, redness in the eyes, bulging eyes, or double vision, especially with certain types of blood vessel issues in the brain. Intracranial Hemorrhage: Sudden symptoms like a severe headache, nausea, vomiting, changes in consciousness, or problems with movement or sensation. Seizures: These can occur due to irritation in the brain caused by blood flow issues or bleeding. Myelopathy: In cases of spinal blood vessel problems, symptoms may include back pain, weakness, changes in sensation, or trouble with bladder and bowel control. […] Symptoms vary by location and size, including pulsatile tinnitus, headaches, neurological deficits, visual disturbances, seizures, and, in severe cases, subarachnoid hemorrhage.

• #15 Arteriovenous Fistula (DAVF) Treatment Options | UNC Rex

  https://www.ncneurospine.com/neuroscience-medical-services/neuroendovascular/arteriovenous-fistula-davf/

  Dural Arteriovenous Fistulas (dAVFs) are unusual connections that form between an artery and a vein within the durable protective covering enveloping the brain or spinal cord, known as the dura mater. […] Dural AVFs tend to manifest later in life, typically in individuals aged 50 to 60 years, and they are generally not associated with genetic inheritance. […] In some instances, individuals with dAVFs may not exhibit any symptoms. However, when symptoms do manifest, they can be broadly categorized as either aggressive or benign in nature. […] These aggressive symptoms encompass: Difficulty walking and an increased risk of falls. Seizures. Speech or language difficulties. Facial pain. Dementia. Parkinsonism-like symptoms. Coordination challenges. Burning or prickling sensations. Muscle weakness. Apathy. Failure to thrive. Symptoms indicative of elevated pressure, such as headaches, nausea, and vomiting.

• #16 Dural arteriovenous fistulas and headache features: an observational study | The Journal of Headache and Pain | Full Text

  https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-020-1073-1

  Dural arteriovenous fistulas are intracranial vascular malformations, fed by dural arteries and draining venous sinuses or meningeal veins. Clinical course varies widely and ranges from benign with spontaneous remission to fatal, due to cerebral hemorrhage. […] Interestingly, we found that the migraine-like headache was the major onset symptom of dural arteriovenous fistulas different from carotid-cavernous fistulas (p=0.036). On the other hand, non-migraine-like headache was a typical characteristic of carotid-cavernous fistulas (p=0.003). […] These findings suggest a link between the site of lesion and clinical features of the headache, a symptom that usually leads to hospitalization. In particular, ocular symptoms accompanying non-migraine-like headache should be promptly recognized and raise the suspicion of a carotid-cavernous fistula, while migraine-like headache may suggest other dural arteriovenous fistulas.

• #17 Dural arteriovenous fistula | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/dural-arteriovenous-fistula?lang=us

  Dural arteriovenous fistulas (dAVF) are a heterogeneous collection of conditions that share arteriovenous shunts from dural vessels. They present variably with hemorrhage or venous hypertension and can be challenging to treat. […] Clinical presentation is highly variable and depends on the location of the supplying and draining vessels, as well as the presence of complications. Presentations include pulsatile tinnitus, cranial nerve palsies, seizures, orbital symptoms, and symptoms of venous hypertension such as raised intracranial pressure and focal neurological deficits. […] Treatment largely depends on the classification of the fistula and the age and comorbidities of the patient, as well as the presence of symptoms directly attributable to the fistula. Higher grades have an annual mortality rate of ~10% and an annual risk of intracranial hemorrhage of ~8%, so treatment should be considered. […] The likelihood of complications depends on the venous drainage, and not the arterial supply, with potential complications including hemorrhage and venous congestion/hypertension and edema.

• #18 Dural arteriovenous fistula | Inselspital, Bern University Hospital

  https://neurochirurgie.insel.ch/en/diseases-specialities/cerebral-vessels/dural-arteriovenous-fistula

  Dural arteriovenous fistulas (dAVFs) are acquired vascular malformations in which there is a pathological connection between arterial vessels of the meninges and venous vessels of the brain or spinal cord. The symptoms are often non-specific, which can delay diagnosis. It is therefore important to think of this clinical picture when complaints such as gait disturbances, headaches or neurological symptoms occur for which no cause can initially be found. […] Through the pathological connection of arteries and veins, the blood flows into the venous system at high arterial pressure. This leads to venous congestion and edema in the surrounding tissue, which can cause neurological deficits but also epileptic seizures. […] Depending on the location of the fistula, pulse-synchronous ringing in the ears due to the perception of the flow noise or a visual impairment can occur. A dural arteriovenous fistula in the area of the spinal cord usually leads to a slowly progressing gait disorder, which can culminate in a paraplegic syndrome. High-grade dural AVFs can also hemorrhage and cause permanent neurological deficits. […] Spinal dural arteriovenous fistulas usually cause venous blood stasis in the spinal cord, which can lead to slowly progressive damage to the spinal cord with symptoms ranging from gait disturbance and weakness in the legs to paraplegia.

• #19 Dural Arteriovenous Fistula – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK532274/

  The outcome depends on the degree of neurological deficit and symptoms. In most patients, the pulsatile tinnitus can be cured by closing the fistula. Both the seizures and visual problems can improve significantly after therapy. […] Higher grades (Borden types II and III, Cognard types IIb-V) have an annual mortality rate of approximately 10% and an annual risk of intracranial hemorrhage of approximately 8%. Non-hemorrhagic neurological deficits have an annual risk of approximately 7%.

• #20 Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR): rationale, design, and initial characterization of patient cohort in: Journal of Neurosurgery Volume 136 Issue 4 (2021) Journals

  https://thejns.org/view/journals/j-neurosurg/136/4/article-p951.xml

  Of the total 1077 patients, 359 (33%) had Borden type I dAVFs, 175 (16%) had Borden type II fistulas, and 529 (49%) had Borden type III fistulas. Of the 359 patients with Borden type I dAVFs, most presented with venous flow-related symptoms such as tinnitus or orbital phenomena (74%, 265/359) or incidentally (25%, 90/359). Two patients (0.6%) presented with fistula-related ICH, and 2 (0.6%) presented with NHNDs. […] There was a strong bias toward treatment in this patient cohort with most (65%) type 1 dAVFs undergoing treatment, approaching universal treatment (94% and 96%) for the higher-grade fistulas.

• #21

  https://link.springer.com/article/10.1007/s44326-024-00017-y

  Kim et al. demonstrated by analyzing their results of the prospective study of 112 patients followed without treatment after the initial diagnosis of DAVFs, that DAVFs are a dynamic disease that may undergo spontaneous angiographic pattern conversions. […] The only parameter that really influences the spontaneous occlusion of DAVFs is their architecture. […] This study documents the association between the presence of a sparse and restricted network with the nidus of the DAVFs and the increased incidence of spontaneous resolution. […] Spontaneous resolution occurred in 50% of cases, a rate higher than the 044% reported in the literature. […] The study revealed that MRI has lower sensitivity compared to angiography for detecting this type of fistula. […] The architecture of DAVFs, such as those with slow flow or specific venous drainage patterns, should guide the selection of embolic materials and approaches.

• #22

  https://link.springer.com/article/10.1007/s44326-024-00017-y

  The predictive factors of thrombosis, which seems to be the pivotal condition for the resolution of DAVFs, considering the systematic review of all the studies in the literature, seem to be mainly two: stasis and endothelial damage. […] In conclusion, these factors do not always seem to be decisive for the spontaneous resolution of DAVFs and further prospective studies should be carried out in the future to clarify the closure mechanism, which currently remains uncertain.

• #23 Dural Arteriovenous Fistula (dAVF) – Toronto Neurovascular Group

  https://torontoneurovascular.com/become-our-patient/dural-arteriovenous-fistula-davf/

  If my symptoms go away suddenly, does that mean I am cured? Not necessarily. Sometimes this means that indeed the fistula has closed off, and the high-pressure blood from the arteries is no longer being shunted into the veins around the brain. Sometimes however this can mean that the blood has found another drainage route from the brain. Occasionally, these means the the dAVF can change from a low-grade (safer) type to a high-grade (more dangerous) type. This is why it is very important that if you know you have a dAVF and your symptoms change significantly, you should arrange to come back and see us in our clinic urgently. […] Showing progressive worsening There is worsening reflux of blood in to the veins.

• #24 Clinical presentation and prognostic factors of spinal dural arteriovenous fistulas: an overview – PubMed

  https://pubmed.ncbi.nlm.nih.gov/22537126/

  Spinal dural arteriovenous fistulas (AVFs), the most common type of spinal cord vascular malformation, can be a challenge to diagnose and treat promptly. The disorder is rare, and the presenting clinical symptoms and signs are nonspecific and insidious at onset. Spinal dural AVFs preferentially affect middle-aged men, and patients most commonly present with gait abnormality or lower-extremity weakness and sensory disturbances. Symptoms gradually progress or decline in a stepwise manner and are commonly associated with pain and sphincter disturbances. […] Motor symptoms are most likely to improve after treatment, followed by sensory disturbances, and lastly sphincter disturbances. Patients with severe neurological deficits at presentation tend to have worse posttreatment functional outcomes than those with mild or moderate pretreatment disability. However, improvement or stabilization of symptoms is seen in the vast majority of treated patients, and thus treatment is justified even in patients with substantial neurological deficits. The extent of intramedullary spinal cord T2 signal abnormality does not correlate with outcomes and should not be used as a prognostic factor.

• #25 Spinal Dural Arteriovenous Fistula: The Missing-Piece Sign | Ochsner Journal

  https://www.ochsnerjournal.org/content/22/1/10

  Spinal dural arteriovenous fistulas (sDAVFs) are a rare and often underdiagnosed spinal pathology. Presenting clinical symptoms are often insidious in onset and of nonspecific nature, such as lower extremity peripheral neuropathies, pain, and exertional leg weakness. Symptoms may progress slowly, over several years, to severe myelopathy with paraplegia. Early diagnosis of sDAVFs is important; deficits are potentially reversible, but delayed treatment may result in irreversible neurologic disability. […] At 1-year follow-up, her symptoms were mildly improved. She still required a rolling walker to ambulate and occasionally self-catheterized because of urinary retention. […] Because of the insidious onset and nonspecific nature of presenting clinical symptoms, sDAVFs are frequently overlooked and often misdiagnosed.

• #26 Spinal dural arteriovenous fistula | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/spinal-dural-arteriovenous-fistula?lang=us

  Spinal dural arteriovenous fistulas (SDAVFs) cause symptoms through venous hypertension and congestion of the cord with edema. The most common clinical presentations are progressive pain, lower extremity weakness or sensory changes. Sphincter dysfunction may also occur. The onset of symptoms is insidious with a slowly progressive course occurring over several years. There is often a significant delay between presentation and diagnosis. […] After treatment of the fistula, the T2 hyperintensity, prominent flow voids, and enhancement should decrease with time but can persist for up to a year. These postoperative imaging features do not correlate with clinical outcome. If treated early, motor and sensory function can be improved or stabilized in most cases. Pain and bowel and bladder dysfunction are only reversed in a minority of patients.

• #27 Spinal Dural Fistula | neuroangio.org

  https://neuroangio.org/patient-information/patient-information-spinal-fistula/

  Fistula means abnormal connection between two structures that are normally not connected. An arteriovenous fistula is therefore an abnormal connection between an artery and a vein. […] A spinal fistula, particularly spinal dural fistula, is usually an abnormal connection between an artery and a vein that are located near the covering of the spinal cord. […] When a fistula forms, blood from an artery under high pressure and flow goes directly into a vein, which is a low pressure and low flow structure. […] Even though the dural fistula is usually not directly on or within the spinal cord, it nevertheless causes dysfunction of the spinal cord by congesting the venous system, as will be explained below. […] The way fistulas cause trouble is by preventing normal spinal cord blood circulation.

• #28 Spinal Dural Fistula | neuroangio.org

  https://neuroangio.org/patient-information/patient-information-spinal-fistula/

  This causes congestion (backup) of fistula blood into spinal cord veins. […] The backup of blood prevents the spinal cord from draining the blood that goes to it, since spinal cord blood has to overcome higher pressures created by the fistula to exit the cord. […] This causes the spinal cord to swell and malfunction. […] As time goes on, the situation gets progressively worse. […] The veins which drain the fistula eventually become diseased and often cose down (thrombose). […] Failure of these draining veins worsens already existing spinal cord congestion and makes symptoms worse. […] Irreversible damage to the spinal cord (myelopathy) eventually results. […] The patient may end up paraplegic (unable to move legs), impotent, and unable to control bowel and bladder. […] Most fistulas, however, grow over time, NOT in the same way a cancer grows, but by hypertrophy (enlargement, rather than neoplasia or new growth) of additional arteries leading to the fistula.

• #29 Dural Arteriovenous Fistula – Interventional Neuroradiology | UCLA Health

  https://www.uclahealth.org/medical-services/radiology/interventional-neuroradiology/diseases-treated/dural-arteriovenous-fistula

  Most DAVF’s are thought to be an acquired disease. DAVF’s can be formed in the following conditions: dural sinus thrombosis (clotting and blockage of the dural sinuses), head injury, and open surgery. […] The symptoms of DAVFs vary depending on the location of DAVF. Headache is one of the non-specific symptoms that could be associated with all types of DAVFs. […] Patients with DAVFs behind the eye (cavernous DAVFs) usually complain of decreased vision and redness / congestion / swelling of the eye. Patients with DAVFs behind the ear (transverse / sigmoid DAVFs) frequently hear a pulsating noise (tinnitus) due to the fast blood flow going through the fistulas. […] All types of DAVFs can cause stroke-type symptoms and seizures. Brain hemorrhage is the most serious presentation of DAVFs and can cause permanent disability and death. Some DAVFs do not present any symptoms at all. However, severity of the symptoms is not necessarily associated with the risk of brain hemorrhage. For example, DAVFs without any symptoms can cause brain hemorrhage.

• #30

  https://link.springer.com/article/10.1007/s00701-021-04950-9

  Cranial dural arteriovenous fistulas (dAVFs) are rare lesions managed mainly with endovascular treatment (EVT) and/or surgery. […] They may be discovered incidentally, but depending on their location and venous drainage, they may cause pulsatile tinnitus, headache, ocular and neurological symptoms, or intracranial hemorrhage. […] Presenting and residual symptoms of the 75 non-hemorrhagic patients are listed in Table 4. Headache was a common presenting symptom of dAVFs in all locations whereas pulsatile tinnitus and ocular symptoms were mostly linked to dAVFs located close to the middle ear and the cavernous sinus: in 39/45 and 12/14 cases, respectively. […] Residual headache was significantly more common than residuals of other symptoms. […] The 23 hemorrhagic patients presented with one out of two distinct separate symptoms: acute headache (n=19, 83%) or acute neurological symptoms without headache (n=4, 17%).

• #31

  https://journals.lww.com/md-journal/fulltext/2023/11100/dural_arteriovenous_fistula_with_progressive.101.aspx

  Dural arteriovenous fistulas (DAVFs) are rare cerebral abnormal arteriovenous anastomoses. It is uncommon for DAVFs with parkinsonism and dementia, so it is easily misdiagnosed. Neuroimaging examinations show that multifocal DAVFs are related to venous thrombosis and white matter changes, suggesting that cerebral circulatory disorders caused by venous hypertensive encephalopathy lead to dementia in patients. […] We report 2 cases, one caused by bilateral white matter lesions and the other caused by bilateral thalamus lesions. Their symptoms are all manifested as progressive dementia and parkinsonism. […] The first patient developed progressive cognitive impairment, 6 months later, the patient developed bedridden, incontinence, and severe cognitive function. The second patient became increasingly bedridden 3 months after discharge and died of aspiration pneumonia.

• #32 Diagnosis and treatment of a dural arteriovenous fistula presenting with progressive parkinsonism and dementia: A case report and literature review

  https://www.spandidos-publications.com/10.3892/etm.2014.2122

  A dural arteriovenous fistula (DAVF) presenting with parkinsonism and dementia is rare; thus, is easily misdiagnosed. […] The initial symptoms were progressive symmetrical limb stiffness and weakness without significant limb tremor, and subsequently the appearance of progressive memory loss, behavioral abnormalities and a decline in the activities of daily living. […] In conclusion, progressive parkinsonism and dementia with an abnormal flow void shadow on cranial MRI films should be considered as a possible diagnosis of a DAVF. […] The symptoms of the DAVF were progressive parkinsonism and dementia, which is rare and has been rarely reported. […] The initial symptoms were progressive limb stiffness and weakness with symmetrical onset; however, there was no significant limb tremor, abnormal posture and difficulty in starting to walk.

• #33

  https://journals.lww.com/md-journal/fulltext/2023/11100/dural_arteriovenous_fistula_with_progressive.101.aspx

  There are few reports of progressive dementia and parkinsonism in DAVF patients, and neurologists should be vigilant to avoid misdiagnosing DAVF. […] However, there are few reports of progressive dementia with parkinsonism. Here, we report 2 patients with DAVFs with concurrent progressive dementia with parkinsonism. […] The mechanism by which DAVFs cause parkinsonism is unclear. One explanation is that parkinsonism manifests due to impaired deep vein drainage and insufficient perfusion of the basal ganglia, consistent with our second case report. Another is that hypoperfusion of the frontal lobe caused by venous hypertension is considered to be causative of Parkinson disease in patients with DAVF. […] In conclusion, DAVFs accompanied by dementia and parkinsonism are easily misdiagnosed. Therefore, timely diagnosis is very important to improve treatment efficacy. For progressive dementia with Parkinson disease, when brain MRI scans show white matter lesions, the possibility of DAVF should be considered.

• #34 Dural Arteriovenous Fistula (dAVF): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/dural-arteriovenous-fistula-davf

  Complications of dAVF can be life-threatening and may include: Bleeding within your brain tissue (hemorrhage). Bleeding within your skull but outside of your brain (subdural hematoma). Bleeding between your brain and its protective coverings (subarachnoid hemorrhage). Pressure within your skull (intracranial pressure). Seizures. Stroke. […] Your prognosis depends on many factors, like the location of the fistula and whether bleeding has occurred. With early discovery and treatment, your prognosis is positive. Unfortunately, some dural arteriovenous fistulas can lead to permanent or life-threatening complications. Follow-up care and support are available if complications happen, like physical therapy, occupational therapy and speech therapy.

• #35 Long-Term Outcome of Patients with Spinal Dural Arteriovenous Fistula: The Dilemma of Delayed Diagnosis | American Journal of Neuroradiology

  https://www.ajnr.org/content/41/2/357

  Spinal dural arteriovenous fistulas (sdAVFs) usually become symptomatic in elderly men, who are affected 5 times more often than women. Symptoms caused by sdAVF comprise gait disturbances with or without paresis, sensory disturbances in the lower extremities, pain, and sphincter and erectile dysfunctions. […] The mean duration of symptoms from onset to diagnosis was 20.2 months (median, 10 months; range, 11-20 months). Shorter duration of symptoms at the time of diagnosis was significantly correlated with better outcome of symptoms (P<.05). [...] Among all analyzed clinical factors in our current cohort, only a shorter duration of symptoms before treatment (6 months) was associated with a better long-term outcome. Patient age and the neurologic status at diagnosis had no influence on the long-term outcome.

• #36 Long-Term Outcome of Patients with Spinal Dural Arteriovenous Fistula: The Dilemma of Delayed Diagnosis | American Journal of Neuroradiology

  https://www.ajnr.org/content/41/2/357

  A longer duration of symptoms from onset to diagnosis was significantly associated with worse long-term outcome (P=.008). Patients with a shorter clinical course (6 months) had an improvement of their gait disturbances up to 1 grade on the AL-score. […] Spinal dural arteriovenous fistulas are characterized by interindividually variable clinical presentations that make a determination of specific predictive factors for the long-term outcome more difficult. Our current analysis implies the importance of early diagnosis for a better neurologic outcome. However, despite major developments in neuroradiologic noninvasive diagnostic tools in the past decades, the diagnosis of sdAVF remains markedly delayed.

• #37 Dural arteriovenous fistula (DAVF) Symptoms and Treatment

  https://neuroandvascular.com/blog/dural-arteriovenous-fistula-davf-symptoms-and-treatment/

  Dural arteriovenous fistula (DAVF) Symptoms Treatment […] Patients with DAVFs may experience no symptoms at all. When symptoms do present, they might range from mild to severe. The symptoms are determined by the DAVFs location and drainage pattern. […] Symptoms of Dural AVF are: […] Headache […] Pulsatile tinnitus (ringing in the ears) […] Visual difficulty […] Seizures […] Bruit (sound heard due to unusual blood flow) […] DAVF can over time develop aggressive symptoms like seizures, increased brain pressure with headaches nausea and vomiting (or) cause speech issues, and weakness. […] More aggressive DAVF can rupture and cause bleeding in the brain called hemorrhage. These patients will develop sudden very severe headaches with varying symptoms of stroke neurological disability. Most typically drooping face, arm (or) leg, difficulty speaking (or) becoming confused or sleepy. […] An untreated dural AVF over a period of time may convert itself from a benign type more aggressive type and may cause a catastrophic brain hemorrhage.

• #38 Spinal dural arteriovenous fistula: a comprehensive review of the history, classification systems, management, and prognosis | Chinese Neurosurgical Journal | Full Text

  https://cnjournal.biomedcentral.com/articles/10.1186/s41016-023-00355-y

  Spinal dural arteriovenous fistulas account for the majority of spinal vascular malformations. They are typically located in the thoracolumbar region and are diagnosed in the middle-aged and elderly populations. […] Unlike intracranial dural arteriovenous fistula, spinal dural arteriovenous fistula is progressive in nature. The neurological manifestations, due to venous congestion, tend to be insidious as well as non-specific. These include sensory deficits, such as paresthesia, bilateral and/or unilateral radicular pain affecting the lower limbs, and gait disturbances. […] If left untreated, spinal dural arteriovenous fistula can lead to severe morbidities like progressive myelopathy as well as bladder and bowel dysfunction. It was estimated that 50% of untreated patients would become severely disabled within 3 years of the onset of symptoms.

• #39 Dural Arteriovenous Fistulas | Baylor Medicine

  https://www.bcm.edu/healthcare/specialties/neurosurgery/cerebrovascular-and-stroke-surgery/dural-arteriovenous-fistulas

  Dural arteriovenous fistulas (DAVFs) are abnormal connections between arteries and veins within the covering of the brain (dura). […] DAVFs lead to increased pressure in brain veins which can result in a variety of symptoms. […] Symptoms suggestive of brain hemorrhage include sudden-onset headache, nausea, vomiting, decreased level of consciousness, weakness, numbness and trouble with speech. […] Patients with longstanding, untreated DAVFs can develop cognitive decline with symptoms similar to dementia.

• #40 Endovascular Treatment of Dural Arteriovenous Fistulas Using Transarterial Liquid Embolization in Combination with Transvenous Balloon-Assisted Protection of the Venous Sinus | American Journal of Neuroradiology

  http://www.ajnr.org/content/39/7/1296

  Dural arteriovenous fistulas (dAVFs) are pathologic, usually acquired connections between dural arteries and dural venous sinuses or cortical veins, resulting in arteriovenous shunting of blood. The 2 major types of clinical presentation are either hemorrhage, with corresponding neurologic deficits, or venous hypertension, with the latter potentially resulting in a variety of symptoms, such as headache, pulsatile tinnitus, visual disturbances, cognitive decline, or seizures. […] All patients were symptomatic, of whom 81.8% presented with tinnitus; 9.1%, with ocular symptoms; and 9.1%, with headache. […] After a mean follow-up of 18 months, most patients (68.2%) achieved complete symptom remission, 27.3% showed symptom relief, and 4.6% had stable symptoms. […] The high rate of complete symptom remission and symptom relief of 95% in our study is in accordance with the results of recently published studies and underlines the effectiveness of endovascular embolization for the treatment of this type of dAVF. […] The overall complete occlusion rate was 86.4%. The overall complication rate was 20%, with transient and permanent morbidity and mortality of 8%, 0%, and 0%, respectively.

• #41 Spinal dural arteriovenous fistula: a case series and review of imaging findings | Spinal Cord Series and Cases

  https://www.nature.com/articles/scsandc201724

  The average delay to diagnosis in our series was 55 weeks. This is correlated with several studies reporting average delays of 13 years with as many as 10-34% of patients have taken even longer than 3 years. […] The concern with such a delay to diagnosis is that many patients develop severe neurological changes including spastic paraplegia, flaccid paralysis and eventually loss of sphincter control. […] In our series, those who had longer delays to diagnosis and significant preoperative disability (Nurick grade 3-5) improved the least.

• #41 Spinal dural arteriovenous fistula: a case series and review of imaging findings | Spinal Cord Series and Cases

  https://www.nature.com/articles/scsandc201724

  Spinal dural arteriovenous fistulae (sdAVF) are rare lesions. Patients typically present with slowly progressive myelopathy that is often mistaken for degenerative cervical or lumbar stenosis. […] Patients with sdAVF often present with non-specific clinical features that are related to progressive myelopathy. Frequently they are misdiagnosed as having other more common spinal pathologies, which can lead to a significant delay in diagnosis, treatment and poorer prognosis. The average patient will present 13 years before the diagnosis is made. […] The majority of patients present with slowly progressive lower extremity weakness, ascending sensory changes and variable bowel and bladder involvement. […] Most patients will present with lower extremity sensory disturbances (paresthesia and hypoesthesia) that are often patchy and ill-defined. These changes can be unilateral or bilateral and are often asymmetric. Lower extremity weakness is present in varying degrees followed by non-specific back pain and eventual bladder/bowel dysfunction.

• #42 Delayed Diagnosis of Spinal Dural Arteriovenous Fistula: A Case Report and Scoping Review

  https://www.mdpi.com/2077-0383/13/3/711

  Spinal dural arteriovenous fistula (SDAVF) is among the most common arterial shunt diseases typically found in middle aged or older men. […] SDAVF progression may last from several months to years, resulting in irreversible spinal cord damage. However, if it is diagnosed early and the fistula is closed, disease progression can be halted, and complete recovery is likely. […] SDAVF symptoms including progressive lower-limb weakness, paresthesia, and vesicorectal dysfunction are indications for spinal magnetic resonance imaging with subsequent spinal angiography, wherein DAVF is evidenced by extensive T2 hyperintensity and flow-void abnormalities. […] A typical patient with SDAVF has symptoms similar to thoracic myelopathy, epiconus syndrome, and conus medullaris syndrome. […] If a patient’s symptoms do not fit with common spinal stenosis, SDAVF should be included in the differential diagnosis.

• #43 Spinal Dural Fistula | neuroangio.org

  https://neuroangio.org/patient-information/patient-information-spinal-fistula/

  As spinal cord swelling gradually develops, most patients start to have some problems with leg weakness, back and leg pain, and issues related to their bladder and bowel. […] The bowel and bladder problems can also be vague, a person may feel they cannot start urinating as well as they could, of feel that they cannot empty their bladder as well as they should, or may not feel the urge to urinate and therefore have some incontinence. […] Other problems patients report are impotence, abnormal sensations in the legs, which can be very variable, such as pins and needles, numbness, burning etc. […] The problem with diagnosing the fistula early, before catastrophic dysfunction develops, is that at first the symptoms are usually nonspecific meaning that they dont for sure imply that the patient has a fistula.

• #44 Dural Arteriovenous Fistula Manifested as Rapid Progressive Dementia Successfully Treated by Endovascular Embolization Only

  https://neurointervention.org/journal/view.php?number=138

  For patients with rapidly progressive dementia, prompt management of a DAVF is important before further deterioration of cognitive function. Therefore, early intervention through surgery or endovascular embolization is important. […] In addition to emphasizing the importance of a quick diagnosis, our case showed that endovascular therapy alone can completely obliterate a DAVF located in the posterior fossa.

• #45 Delayed Diagnosis of Spinal Dural Arteriovenous Fistula: A Case Report and Scoping Review

  https://www.mdpi.com/2077-0383/13/3/711

  The primary reason for delayed and incorrect SDAVF diagnosis is that SDAVF is easily misrepresented as other diseases. […] SDAVF treatment includes microsurgery and embolization. The treatment goal is to prevent the flow of blood from the proximal intradural vein and fistula. If treatment is delayed, lower-limb weakness, paresthesia, and bladder–rectal dysfunction can persist. Early diagnosis and treatment are therefore essential; results emphasize their importance in SDAVF. […] SDAVF is frequently misdiagnosed due to its nonspecific features, and late diagnosis can worsen the prognosis. Spinal MRI should be conducted in patients presenting symptoms such as slowly progressive lower-limb weakness, paresthesia, and vesicorectal dysfunction.

• #46 Spinal Dural Fistula | neuroangio.org

  https://neuroangio.org/patient-information/patient-information-spinal-fistula/

  Most patients have symptoms of the fistula for one or more years before they are diagnosed. […] Once the fistula is closed, spinal cord blood circulation gets better, but usually does not go back to normal. […] The patients symptoms may go away completely, partially, or not at all. […] Overall, most patients get better. […] The converse is that, without treatment, virtually all patients get worse and will be eventually paralyzed.

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