Intracranial dural arteriovenous fistula mistaken as cervical transverse myelitis

Peethambar, Gowri Anil; Whittam, Daniel; Huda, Saif; Alusi, Sundus; Puthuran, Mani; Arun, Chandran; Eldridge, Paul; Jacob, Anu

doi:10.1136/practneurol-2018-002091

Cited by 4 publications

(4 citation statements)

References 4 publications

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“…These AVFs are associated with tortuous vessel dilatation, venous hypertension, flow voids, haemorrhage and oedema, being strikingly reminiscent of choroidal abnormalities in pachychoroid spectrum diseases (Gandhi et al 2012;Laakso & Hernesniemi 2012;Nasr et al 2017;Spaide et al 2021). Intriguingly, after administration of corticosteroids, dural AVFs have been observed to induce (sub)acute worsening of neurological complaints (DiSano et al 2017;Nasr et al 2017;Peethambar et al 2019;Le Goueff et al 2020). This phenomenon has been described in multiple case reports of neurological patients that were initially misdiagnosed with for example an auto-immune neurological disorder, for which corticosteroids were prescribed.…”

Section: Corticosteroids and Sex Differences Are Associated With Both...mentioning

confidence: 99%

Choroidal arteriovenous anastomoses: a hypothesis for the pathogenesis of central serous chorioretinopathy and other pachychoroid disease spectrum abnormalities

Brinks

Dijk

Meijer

et al. 2022

Acta Ophthalmologica

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The pachychoroid disease spectrum (PDS) includes several chorioretinal diseases that share specific choroidal abnormalities. Although their pathophysiological basis is poorly understood, diseases that are part of the PDS have been hypothesized to be the result of venous congestion. Within the PDS, central serous chorioretinopathy is the most common condition associated with vision loss, due to an accumulation of subretinal fluid in the macula. Central serous chorioretinopathy is characterized by distinct risk factors, most notably a high prevalence in males and exposure to corticosteroids. Interestingly, sex differences and corticosteroids are also strongly associated with specific types of arteriovenous anastomoses in the human body, including dural arteriovenous fistula and surgically created arteriovenous shunts. In this manuscript, we assess the potential of such arteriovenous anastomoses in the choroid as a causal mechanism of the PDS. We propose how this may provide a novel unifying concept on the pathophysiological basis of the PDS, and present cases in which this mechanism may play a role.

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Section: Corticosteroids and Sex Differences Are Associated With Both...mentioning

confidence: 99%

Choroidal arteriovenous anastomoses: a hypothesis for the pathogenesis of central serous chorioretinopathy and other pachychoroid disease spectrum abnormalities

Brinks

Dijk

Meijer

et al. 2022

Acta Ophthalmologica

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“…It is important to notice that (1) mildly elevated CSF protein and absence of CSF pleocytosis (“albumino-cytological dissociation”) may occur in arteriovenous fistula and therefore should not necessarily be attributed to idiopathic transverse myelitis or Guillain-Barrè syndrome; (2) post steroid worsening should raise the suspicion about a non-inflammatory disease of the spinal cord, particularly a spinal or an intracranial fistula [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Watch brain circulation in unexplained progressive myelopathy: a review of Cognard type V arterio-venous fistulas

et al. 2023

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Background Intracranial dural arterio-venous fistulas are pathological anastomoses between arteries and veins located within dural sheets and whose clinical manifestations depend on location and hemodynamic features. They can sometimes display perimedullary venous drainage (Cognard type V fistulas—CVFs) and present as a progressive myelopathy. Our review aims at describing CVFs’ variety of clinical presentation, investigating a possible association between diagnostic delay and outcome and assessing whether there is a correlation between clinical and/or radiological signs and clinical outcomes. Methods We conducted a systematic search on Pubmed, looking for articles describing patients with CVFs complicated with myelopathy. Results A total of 72 articles for an overall of 100 patients were selected. The mean age was 56.20 ± 14.07, 72% of patients were man, and 58% received an initial misdiagnosis. CVFs showed a progressive onset in 65% of cases, beginning with motor symptoms in 79% of cases. As for the MRI, 81% presented spinal flow voids. The median time from symptoms’ onset to diagnosis was 5 months with longer delays for patients experiencing worse outcomes. Finally, 67.1% of patients showed poor outcomes while the remaining 32.9% obtained a partial-to-full recovery. Conclusions We confirmed CVFs’ broad clinical spectrum of presentation and found that the outcome is not associated with the severity of the clinical picture at onset, but it has a negative correlation with the length of diagnostic delay. We furthermore underlined the importance of cervico-dorsal perimedullary T1/T2 flow voids as a reliable MRI parameter to orient the diagnosis and distinguish CVFs from most of their mimics.

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“…1,9,[19][20][21][24][25][26] When embolization was attempted (8 of 20 cases), the procedure had to be repeated in 1 case, and in 4 others, microsurgery was the final treatment. 9,18,22,23,[27][28][29] The initial trigger of DAVFs is unknown. Nevertheless, in some cases such as ours, previous head trauma is reported.…”

Section: Discussionmentioning

confidence: 99%

“…Also, the embolization of meningeal ICA feeders is difficult; risky; and, as detailed in Table 1 , when attempted, the number of cases requiring additional treatment, predominantly microsurgery, was not negligible. 9 , 23 , 24 , 27 , 29 For this reason, given the feasibility and in order to avoid further risk or delay in a very fragile patient, we directly opted for the open procedure. Therefore, although endovascular treatment has become the leading therapy for intracranial DAVFs, tentorial DAVFs may require microsurgical discontinuation.…”

Section: Discussionmentioning

confidence: 99%

Tentorial dural arteriovenous fistula with perimedullary venous drainage–associated cervical myelopathy: illustrative case

Codina¹,

García²,

Sánchez³

et al. 2022

Journal of Neurosurgery: Case Lessons

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BACKGROUND Tentorial dural arteriovenous fistulas (DAVFs) with perimedullary venous drainage causing cervical myelopathy are very uncommon conditions with an extremely aggressive behavior. When the characteristic radiological clues are missing, the unspecific clinical picture may cause delay and make the diagnosis challenging. OBSERVATIONS Here the authors report a case of a 58-year-old man who developed progressive spastic tetraparesis and dyspnea with an extensive mild enhancing cervical cord lesion initially oriented as a neurosyphilis-associated transverse myelitis. Acute worsening after steroid administration redirected the diagnosis, and a tentorial Cognard type V DAVF was elicited. The microsurgical disconnection process is described, and previously documented cases in the literature are reviewed. LESSONS If a DAVF is highly suspected, it is important to consider the possibility of its intracranial origin, and spinal as well as cerebral arteriography must be performed.

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Intracranial dural arteriovenous fistula mistaken as cervical transverse myelitis

Cited by 4 publications

References 4 publications

Choroidal arteriovenous anastomoses: a hypothesis for the pathogenesis of central serous chorioretinopathy and other pachychoroid disease spectrum abnormalities

Choroidal arteriovenous anastomoses: a hypothesis for the pathogenesis of central serous chorioretinopathy and other pachychoroid disease spectrum abnormalities

Watch brain circulation in unexplained progressive myelopathy: a review of Cognard type V arterio-venous fistulas

Tentorial dural arteriovenous fistula with perimedullary venous drainage–associated cervical myelopathy: illustrative case

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