Positional vomiting due to a thoracic spinal dural arteriovenous fistula

2004 ◽  
Vol 1 (2) ◽  
pp. 219-222 ◽  
Author(s):  
Dennis J. Cordato ◽  
Mark A. Davies ◽  
Lynette T. Masters ◽  
Phillip D. Cremer ◽  
Raymond S. Schwartz ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Venous Hypertension ◽  
High Signal ◽  
Spinal Dural Arteriovenous Fistula ◽  
Content Type ◽  
Signal Abnormality ◽  
Thoracic Spinal ◽  
The Brain

✓ The authors report the unique case of a patient with a thoracic spinal dural arteriovenous fistula (DAVF) causing remote brainstem symptoms of positional vomiting and minimal vertigo. Magnetic resonance (MR) imaging of the brain demonstrated high signal abnormality in the medulla, presumably related to venous hypertension, and spinal MR imaging revealed markedly dilated veins along the dorsal aspect of the cord. Spinal angiography confirmed the presence of a thoracic spinal DAVF. Disconnection of the DAVF from the spine resulted in a marked improvement in symptoms and resolution of the preoperative MR imaging—documented abnormalities. The authors highlight the rare syndrome of positional vomiting as a brainstem symptom and conclude that spinal DAVFs should be considered in the differential diagnosis of high signal MR imaging abnormalities localized to the brainstem.

A sacral dural arteriovenous fistula presenting with an intermittent myelopathy aggravated by menstruation

1991 ◽  
Vol 75 (6) ◽  
pp. 947-949 ◽  
Author(s):  
Dong-Ik Kim ◽  
In-Sup Choi ◽  
Alex Berenstein
Keyword(s):  
Arteriovenous Fistula ◽  
Clinical Manifestation ◽  
Dural Arteriovenous Fistula ◽  
Venous Drainage ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Spinal Dural Arteriovenous Fistula ◽  
Content Type ◽  
Repeat Angiography ◽  
Fine Print

✓ The case is reported of a woman with a spinal dural arteriovenous fistula whose intermittent myelopathy became aggravated with menstruation. Her symptoms recurred in spite of successful acrylic embolization of the lateral sacral arteriovenous fistula. Repeat angiography showed venous drainage from the uterus toward the medullary vein. Total abdominal hysterectomy cured her symptoms. The pathophysiological basis for this peculiar clinical manifestation and its management are discussed.

Angiographically occult spinal dural arteriovenous fistula located using selective computed tomography angiography

2007 ◽  
Vol 7 (2) ◽  
pp. 215-220 ◽  
Author(s):  
Taku Sugawara ◽  
Yoshitaka Hirano ◽  
Yasunobu Itoh ◽  
Hiroyuki Kinouchi ◽  
Satoshi Takahashi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Spinal Cord ◽  
Mr Imaging ◽  
Arteriovenous Fistula ◽  
Ct Angiography ◽  
Dural Arteriovenous Fistula ◽  
Low Flow ◽  
Spinal Dural Arteriovenous Fistula ◽  
Coronary Veins ◽  
Spinal Arteriovenous Malformation

✓Spinal dural arteriovenous fistula (DAVF) is the most common type of spinal arteriovenous malformation and may cause progressive myelopathy but is usually treatable in the early stages by direct surgery or intravascular embolization. Selective spinal angiography has been the gold standard for diagnosis, but angiographically occult DAVF is not uncommon. A 67-year-old man presented with a 2-year history of progressive paraparesis. Magnetic resonance (MR) imaging demonstrated segmental atrophy of the spinal cord and dilated coronary veins on the dorsal surface of the spinal cord. A DAVF was suspected, but repeated selective angiography failed to demonstrate the fistula. Findings from spoiled gradient echo MR imaging suggested that the draining vein flowed into the dilated venous plexus at the T-9 level. Selective computed tomography (CT) angiography of the right T-9 intercostal artery confirmed the location of the fistula. The authors successfully occluded the draining vein through surgery, and they observed that the fistula was low flow. The patient exhibited improvement in his symptoms, and postoperative MR imaging confirmed closure of the fistula. Selective CT angiography is useful in locating the draining vein of angiographically occult DAVF and therefore minimizing the extent of the surgical procedure.

scholarly journals Mimicking Amyotrophic Lateral Sclerosis: A Case of a Spinal Dural Arteriovenous Fistula

2021 ◽  
pp. 802-806
Author(s):  
Mónica Santos ◽  
Sofia Reimão ◽  
Mamede de Carvalho
Keyword(s):  
Spinal Cord ◽  
Amyotrophic Lateral Sclerosis ◽  
Arteriovenous Fistula ◽  
Vascular Malformation ◽  
Dural Arteriovenous Fistula ◽  
Venous Hypertension ◽  
Lower Limbs ◽  
Spinal Dural Arteriovenous Fistula ◽  
Conventional Angiography ◽  
Lateral Sclerosis

A number of conditions can mimic amyotrophic lateral sclerosis (ALS), which are in general excluded by neurophysiological and neuroimaging investigation. We present a novel mimicking disorder. A 58-year-old male, without relevant past medical history, presented with a 7-year history of progressive paraparesis. On examination, he had bilateral thigh atrophy, fasciculations, and asymmetric paraparesis (severe on the left side). Upper motor neuron signs were present in the lower limbs, with normal sensory examination. Needle EMG disclosed mild chronic neurogenic changes in the lower limbs. Brain and spinal cord neuroimaging was normal, namely, in the dorso-lumbar segment. Lumbar puncture showed mild hyperproteinorachia. Diagnosis of slowly progressive (possible) ALS was established. One year later, he required a bilateral support to walk, and neurological examination revealed weak tendon reflexes, abnormal pinprick, and proprioceptive sensation in the legs. Repeated lumbar MRI showed an extensive spinal cord oedema from T7 to the conus with multiple perimedullary vessel flow voids suggestive of a vascular malformation. Conventional angiography revealed a spinal dural arteriovenous fistula in L2–L3 with the left L4 lumbar branch as the afferent artery. Dural arteriovenous fistula is the most common vascular malformation of the spinal cord, despite being rare. It leads to arterialization of spinal veins, causing venous hypertension, spinal cord oedema, and ischaemia. The clinical picture includes a stepwise, sometimes fluctuant, myeloradiculopathy. In this case, EMG changes did not meet Awaji criteria. This case reinforces the need to critically follow atypical cases to ascertain clinical progression in patients with suspected ALS.

Dural arteriovenous fistula and progressive conus medullaris syndrome as complications of lumbar discectomy

2002 ◽  
Vol 97 (3) ◽  
pp. 375-379 ◽  
Author(s):  
Keizoh Asakuno ◽  
Phyo Kim ◽  
Toshiki Kawamoto ◽  
Masahiro Ogino
Keyword(s):  
Mr Imaging ◽  
Arteriovenous Fistula ◽  
Nerve Root ◽  
Dural Arteriovenous Fistula ◽  
Lumbar Disc ◽  
Conus Medullaris ◽  
Lumbar Discectomy ◽  
Content Type ◽  
Initial Surgery ◽  
Gastrocnemius Muscles

✓ A case of a dural arteriovenous fistula (DAVF) that developed at the site of nerve root sleeve damage as a result of lumbar disc extrusion is reported. A 60-year-old man who had undergone lumbar discectomy 3 years previously for severe left-sided sciatica and L5—S1 disc herniation presented with progressive gait disturbance. After the initial surgery, the symptoms resolved. Fourteen months after the operation, however, he started to experience dysesthesias in both legs and progressive gait and urinary disturbances. Physical examination revealed a weakness of the anterior tibialis and the gastrocnemius muscles, as well as decreased contractility of the anal sphincter and marked sacral hypesthesia. Magnetic resonance (MR) imaging revealed swelling and a T2 signal elongation in the conus medullaris; angiography demonstrated arteriovenous dural shunting between the left lateral sacral artery and the left S-1 radicular vein at the site of the previous operation. Surgery was conducted to excise the DAVF on the S-1 nerve root sleeve and an arterialized intradural vein on the root. The procedure resulted in resolution of the symptoms and disappearance of the abnormal angiographically and MR imaging—documented anomalies. This is the first report of a DAVF in which progressive conus myelopathy developed after a lumbar discectomy.

scholarly journals Reversible Aggravation of Neurological Deficits after Transforaminal Epidural Steroid Injection in a Patient with Undiagnosed Spinal Dural Arteriovenous Fistula

2020 ◽  
Vol 2 (4) ◽  
pp. 1-4
Author(s):  
Ramon Go ◽  
◽  
Joshua Lantos ◽  
Jeffrey Ngeow ◽  
◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Steroid Injection ◽  
Epidural Injection ◽  
Venous Hypertension ◽  
Epidural Steroid Injection ◽  
Neurological Deficits ◽  
Diagnostic Challenge ◽  
Spinal Dural Arteriovenous Fistula ◽  
Epidural Steroid

Here we present a case of a 77-year-old man who underwent an epidural steroid injection complicated by delayed monoplegia and urinary incontinence. An MRI showed T2 hyperintensity at the conus along with small serpentine vessels surrounding the spinal cord. An angiogram was performed which showed a spinal dural arteriovenous fistula (SDAVF) with prominent draining vein at the right L3 level. The patient underwent repeat laminectomy and disconnection of spinal dural fistula after failed endovascular repair. His symptoms slowly improved after the lumbar decompression and physical therapy. SDAVF remains a diagnostic challenge. Epidural injection is contraindicated in these patients due to venous hypertension resulting in possible conus ischemia. SDAVF must be considered in the differential diagnosis when unexpected neurological complications occur after epidural steroid injection.

Spinal dural arteriovenous fistula presenting with paraplegia following lumbar puncture

2013 ◽  
Vol 19 (1) ◽  
pp. 57-60 ◽  
Author(s):  
Guus Koerts ◽  
Vincent Vanthuyne ◽  
Maxime Delavallee ◽  
Herbert Rooijakkers ◽  
Christian Raftopoulos
Keyword(s):  
Arteriovenous Fistula ◽  
Lumbar Puncture ◽  
Dural Arteriovenous Fistula ◽  
Treatment Options ◽  
Venous Hypertension ◽  
Spinal Dural Arteriovenous Fistula ◽  
Segmental Artery ◽  
Arteriovenous Fistulas ◽  
Underlying Mechanisms ◽  
Spinal Dural Arteriovenous Fistulas

Spinal dural arteriovenous fistulas are rare lesions with an annual incidence of 1 per 100,000 population. In patients with this disease, an abnormal vascular dural shunt exists between a dural branch of a segmental artery and a subdural radicular vein that drains the perimedullary venous system, leading to venous hypertension and secondary congestive myelopathy. Generally, patients present with progressive paraparesis, urinary disturbances, and gait ataxia. In this report the authors describe a 61-year-old woman with a spinal dural arteriovenous fistula who developed an acute paraplegia after a nontraumatic lumbar puncture. The possible underlying mechanisms and treatment options are discussed.

Dural arteriovenous fistula of the lumbar spine presenting with subarachnoid hemorrhage

2004 ◽  
Vol 100 (4) ◽  
pp. 385-391 ◽  
Author(s):  
Christoph Koch ◽  
Stefan Gottschalk ◽  
Alf Giese
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Craniocervical Junction ◽  
Type I ◽  
Spinal Dural Arteriovenous Fistula ◽  
Content Type ◽  
Spinal Arteriovenous Malformation ◽  
First Case ◽  
Imaging Results

✓ The authors report on a patient presenting with subarachnoid hemorrhage (SAH) that was initially attributed to an aneurysm of the right internal carotid artery. During surgical exploration and placement of a clip, however, it was observed that the aneurysm had not ruptured. Diagnostic workup including spinal magnetic resonance imaging revealed a vascular malformation of the lumbar spinal canal within a subarachnoid hematoma. Spinal angiography demonstrated a spinal dural arteriovenous fistula (DAVF) (Type I spinal arteriovenous malformation) with a feeding vessel arising from the L-4 radicular artery. In the literature, SAH due to spinal DAVFs is rare; only cases of dural fistulas of the craniocervical junction and the cervical spine have been reported. This is the first case of SAH that can be attributed to a lumbar DAVF. Although unusual even in cases of cervical DAVF, SAH as a presenting symptom may occur in spinal DAVF of any location. Nontraumatic SAH should not be prematurely attributed to the rupture of an intracranial aneurysm if the clinical findings and imaging results are inconclusive.

Spinal epidural arteriovenous fistula with intramedullary reflux

1997 ◽  
Vol 87 (4) ◽  
pp. 633-635 ◽  
Author(s):  
Farhad Pirouzmand ◽  
M. Christopher Wallace ◽  
Robert Willinsky
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Rare Entity ◽  
Spinal Dural Arteriovenous Fistula ◽  
Content Type ◽  
Spinal Epidural ◽  
Fine Print

✓ A spinal epidural arteriovenous fistula with secondary reflux into the perimedullary veins is a rare entity. The authors present such a case with a discussion of its pathophysiology and treatment. The mechanism for formation of a spinal dural arteriovenous fistula is outlined based on the anatomical substrates in this region.

Spinal Dural Arteriovenous Fistula: Diagnosis and Treatment

2018 ◽  
Vol 1 (2) ◽  
Author(s):  
Nur Setiawan Suroto
Keyword(s):  
Spinal Cord ◽  
Arteriovenous Fistula ◽  
Vascular Malformation ◽  
Dural Arteriovenous Fistula ◽  
Motor Symptoms ◽  
Elderly Men ◽  
Spinal Dural Arteriovenous Fistula ◽  
Sensory Disturbances ◽  
Av Fistulas ◽  
Low Rate

Spinal dural arteriovenous (AV) fistulas are the most commonly encountered vascular malformation of the spinal cord and a treatable cause for progressive paraplegia or tetraplegia. They most commonly affected are elderly men and are classically found in the thoracolumbar region.Symptoms gradually progress or decline in a stepwise manner and are commonly associated with pain and sphincter disturbances. Surgical or endovascular disconnection of the fistula has a high success rate with a low rate of morbidity. Motor symptoms are most likely to improve after treatment, followed by sensory disturbances, and lastly sphincter disturbances.

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