A New Type of Spinal Epidural Arteriovenous Fistulas Causes Spinal Epidural Hemorrhage: An Analysis of Five Cases and Natural History Consideration

2017 ◽  
Vol 103 ◽  
pp. 371-379 ◽  
Author(s):  
Jia-Xing Yu ◽  
Tao Hong ◽  
Yong-Jie Ma ◽  
Feng Ling ◽  
Hong-Qi Zhang
Keyword(s):  
Natural History ◽  
Arteriovenous Fistulas ◽  
New Type ◽  
Epidural Hemorrhage ◽  
Spinal Epidural

Assessing the rate, natural history, and treatment trends of intracranial aneurysms in patients with intracranial dural arteriovenous fistulas: a Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) investigation

2021 ◽  
pp. 1-10
Author(s):  
Isaac Josh Abecassis ◽  
R. Michael Meyer ◽  
Michael R. Levitt ◽  
Jason P. Sheehan ◽  
Ching-Jen Chen ◽  
...  
Keyword(s):  
Natural History ◽  
Arteriovenous Fistula ◽  
Outcomes Research ◽  
Intracranial Aneurysms ◽  
Dural Arteriovenous Fistula ◽  
Aneurysm Rupture ◽  
External Carotid ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas

OBJECTIVE There is a reported elevated risk of cerebral aneurysms in patients with intracranial dural arteriovenous fistulas (dAVFs). However, the natural history, rate of spontaneous regression, and ideal treatment regimen are not well characterized. In this study, the authors aimed to describe the characteristics of patients with dAVFs and intracranial aneurysms and propose a classification system. METHODS The Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) database from 12 centers was retrospectively reviewed. Analysis was performed to compare dAVF patients with (dAVF+ cohort) and without (dAVF-only cohort) concomitant aneurysm. Aneurysms were categorized based on location as a dAVF flow-related aneurysm (FRA) or a dAVF non–flow-related aneurysm (NFRA), with further classification as extra- or intradural. Patients with traumatic pseudoaneurysms or aneurysms with associated arteriovenous malformations were excluded from the analysis. Patient demographics, dAVF anatomical information, aneurysm information, and follow-up data were collected. RESULTS Of the 1077 patients, 1043 were eligible for inclusion, comprising 978 (93.8%) and 65 (6.2%) in the dAVF-only and dAVF+ cohorts, respectively. There were 96 aneurysms in the dAVF+ cohort; 10 patients (1%) harbored 12 FRAs, and 55 patients (5.3%) harbored 84 NFRAs. Dural AVF+ patients had higher rates of smoking (59.3% vs 35.2%, p < 0.001) and illicit drug use (5.8% vs 1.5%, p = 0.02). Sixteen dAVF+ patients (24.6%) presented with aneurysm rupture, which represented 16.7% of the total aneurysms. One patient (1.5%) had aneurysm rupture during follow-up. Patients with dAVF+ were more likely to have a dAVF located in nonconventional locations, less likely to have arterial supply to the dAVF from external carotid artery branches, and more likely to have supply from pial branches. Rates of cortical venous drainage and Borden type distributions were comparable between cohorts. A minority (12.5%) of aneurysms were FRAs. The majority of the aneurysms underwent treatment via either endovascular (36.5%) or microsurgical (15.6%) technique. A small proportion of aneurysms managed conservatively either with or without dAVF treatment spontaneously regressed (6.2%). CONCLUSIONS Patients with dAVF have a similar risk of harboring a concomitant intracranial aneurysm unrelated to the dAVF (5.3%) compared with the general population (approximately 2%–5%) and a rare risk (0.9%) of harboring an FRA. Only 50% of FRAs are intradural. Dural AVF+ patients have differences in dAVF angioarchitecture. A subset of dAVF+ patients harbor FRAs that may regress after dAVF treatment.

Abstract P639: Cerebrovascular and Pathological Findings in Police Chokehold Fatalities

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Brian C Richardson ◽  
Johanna Rengifo ◽  
Michael Stanton ◽  
Neftali Nevarez ◽  
Cristina Román ◽  
...  
Keyword(s):  
Law Enforcement Officers ◽  
Single Subject ◽  
Subdural Hemorrhage ◽  
Middle Range ◽  
Autopsy Data ◽  
History Of ◽  
Epidural Hemorrhage ◽  
Artery Disease ◽  
Cervical Spine Fractures ◽  
Spinal Epidural

Introduction: A number of recent well publicized deaths from police chokeholds have focused attention on the use and safety of chokeholds by law enforcement officers (LEO). LEO chokeholds are depicted as a safe non-lethal restraint technique. Use of chokeholds by LEO is purported to be in the middle range of force options when compared to other tools of force available. LEO chokeholds are often likened to judo chokeholds which have a long history of safety and have not directly contributed to the death of a judoka since the sport of Judo was founded in Japan in 1882. Some have posited that chokeholds employed by LEO are especially likely to be safe in young adults, as they are less likely to have underlying cardiovascular diseases. Chokeholds applied by LEO can unfortunately be associated with severe medical and neurological sequelae, including death. Methods: We reviewed autopsy data of 29 deaths associated with LEO chokeholds. Results: Subjects ranged in age from 19 to 58. Reported chokehold duration ranged from 4 seconds to 3 minutes in length. In ten cases, chokeholds were applied multiple times to a single subject. In one case chokeholds were applied five times to a single subject. At autopsy, two subjects were found to have carotid artery intimal tears. Two subjects had epidural hemorrhages. One subject sustained a subdural hemorrhage. One subject was found to have had a subarachnoid hemorrhage. Five subjects had pathology typical of global cerebral anoxia. One subject sustained multiple cervical spine fractures with crush injury to the spinal cord as well as spinal epidural hemorrhage. Two subjects had evidence of hemorrhage involving the cervical anterior longitudinal ligament. Atherosclerotic heart disease was found in five subjects. Two subjects had severe occlusive coronary artery disease. Four of these subjects were between the ages of 28 and 35. Myocardial fibrosis was found in five subjects. Cardiomegaly was found at autopsy in six subjects. Conclusions: LEO chokeholds are not widely considered to constitute deadly force, however our review of autopsy data from 29 deaths caused by chokeholds applied by LEO revealed that they can be associated with death and severe cerebrovascular, and central nervous system sequela in both young and older subjects.

Management of spinal epidural arteriovenous fistulas: interventional techniques and results

2013 ◽  
Vol 6 (2) ◽  
pp. 144-149 ◽  
Author(s):  
Dinesh Ramanathan ◽  
Michael R Levitt ◽  
Laligam N Sekhar ◽  
Louis J Kim ◽  
Danial K Hallam ◽  
...  
Keyword(s):  
Interventional Techniques ◽  
Arteriovenous Fistulas ◽  
Spinal Epidural

Spinal epidural arteriovenous fistulas associated with progressive myelopathy

2007 ◽  
Vol 6 (6) ◽  
pp. 552-558 ◽  
Author(s):  
Nivaldo Silva ◽  
Anne Christine Januel ◽  
Philippe Tall ◽  
Christophe Cognard
Keyword(s):  
Magnetic Resonance Imaging ◽  
Therapeutic Strategy ◽  
Clinical Symptoms ◽  
Venous Drainage ◽  
Imaging Findings ◽  
Resonance Imaging ◽  
Arterial Access ◽  
Arteriovenous Fistulas ◽  
Progressive Myelopathy ◽  
Spinal Epidural

✓The authors report the cases of four patients who presented with progressive myelopathy (one patient had been asymptomatic for 25 years) due to spinal epidural arteriovenous fistulas (AVFs). Clinical symptoms and magnetic resonance imaging findings were similar to those of dural AVFs. In contrast to dural AVFs, angiography showed that the lesions were fed by multiple vessels and drained in one case in multiple veins. Perimedullary venous drainage was visible in three of the four cases. All fistulas were cured by embolization; arterial access was used in two cases and venous in two. The authors' aim in this paper is to emphasize the differences between dural and epidural AVFs in terms of their physiopathology and angioarchitecture as well as the therapeutic strategy.

scholarly journals Spinal epidural arteriovenous fistula embolization with ethylene vinyl alcohol (EVOH) copolymer using the Scepter Mini dual-lumen balloon

2020 ◽  
pp. neurintsurg-2020-016395
Author(s):  
Frédéric Clarençon ◽  
Eimad Shotar ◽  
Arnaud Pouvelle ◽  
Kevin Premat ◽  
Stéphanie Lenck ◽  
...  
Keyword(s):  
Vinyl Alcohol ◽  
Cord Compression ◽  
Embolic Agent ◽  
Content Type ◽  
Ethylene Vinyl Alcohol ◽  
Arteriovenous Fistulas ◽  
Low Profile ◽  
Liquid Embolic Agent ◽  
Av Fistulas ◽  
Spinal Epidural

Left unattended, spinal epidural arteriovenous fistulas (EAVFs) have a potentially severe clinical course. Embolization using ethylene vinyl alcohol (EVOH) copolymers through regular dual-lumen balloons has emerged as a potential option for the treatment of spinal arteriovenous (AV) fistulas;1–3 the main issue with this technique is the navigability of these balloons. The Scepter Mini is a low-profile, dual-lumen balloon, which may be helpful for EVOH embolization of spinal AV fistulas, as it may help to overcome the navigation drawbacks. In this technical video, we present a case of EVOH embolization of a right T6 spinal EAVF through a Scepter Mini balloon. Of note, particular attention should be paid to radiculomedullary arteries arising at the same level or at adjacent levels to avoid severe neurologic complications related to uncontrolled migration of the liquid embolic agent. Moreover, excessive use of embolic material should be avoided to prevent spinal cord compression (video 1).Video 1

Ultrasound diagnosis of neonatal spinal epidural hemorrhage

1988 ◽  
Vol 16 (6) ◽  
pp. 440-442 ◽  
Author(s):  
M Leadman ◽  
S Seigel ◽  
R Hollenberg ◽  
C Caco
Keyword(s):  
Ultrasound Diagnosis ◽  
Epidural Hemorrhage ◽  
Spinal Epidural

Spinal epidural arteriovenous fistula with perimedullary drainage

2006 ◽  
Vol 5 (4) ◽  
pp. 353-358 ◽  
Author(s):  
Timo Krings ◽  
Michael Mull ◽  
Azize Bostroem ◽  
Juergen Otto ◽  
Franz J. Hans ◽  
...  
Keyword(s):  
Venous Congestion ◽  
Resonance Imaging ◽  
Rare Type ◽  
Arteriovenous Fistulas ◽  
Arteriovenous Shunts ◽  
Dural Arteriovenous Fistulas ◽  
Complete Obliteration ◽  
Spinal Dural Arteriovenous Fistulas ◽  
Spinal Epidural

✓ The classic angiographically demonstrated features of spinal dural arteriovenous fistulas are shunts of radiculomeningeal branches with radicular veins draining exclusively in the direction of perimedullary veins and thereby causing venous congestion. These shunts are located at the point where the radicular vein passes the dura mater. Spinal epidural arteriovenous shunts, however, normally do not drain into the perimedullary veins and are, therefore, asymptomatic, presumably because of a postulated reflux-impeding mechanism between the dural sleeves. The authors report on a patient in whom an epidural arteriovenous shunt showed delayed retrograde drainage into perimedullary veins, leading to the classic clinical (and magnetic resonance imaging–based) findings of venous congestion. Intraoperatively the angiographically established diagnosis was confirmed. Coagulation of both the epidural shunt zone and the radicular vein resulted in complete obliteration of the fistula, as confirmed on repeated angiography. This rare type of fistula should stimulate considerations on the role of valvelike mechanisms normally impeding retrograde flow from the epidural plexus to perimedullary veins and suggest that, in certain pathological circumstances, epidural fistulas can drain retrogradely into perimedullary veins as an infrequent variant of spinal arteriovenous shunts.

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