Feasibility of Noninvasive Diagnosis of Spinal Vascular Diseases Using Time-Resolved Angiography With Stochastic Trajectories

Background and Purpose: To determine the feasibility of time-resolved angiography with stochastic trajectories (TWIST) in the diagnosis of spinal dural arteriovenous fistula (SDAVF) and perimedullary arteriovenous fistula (PAVF).Methods: A total of 11 negative patients with TWIST examination were retrospective analyzed and then 18 patients with suspected spinal vascular diseases underwent TWIST. For negative patients, Adamkiewicz artery (AKA), great anterior radiculomedullary vein (GARV) and anterior spinal artery (ASA) were retrospective analyzed. In patients, the results of TWIST were compared with those of DSA.Results: The displaying rates of the ASA, AKA and GARV in 11 negative patients were 100, 90.9, and 90.9%, respectively. The AKA and GARV were separated on TWIST. Of 18 patients, 11 and three were diagnosed with SDAVF and PAVF, respectively. The spinal cord vascular malformation diagnosed on TWIST was consistent with DSA with an excellent intermodality agreement (Kappa = 0.92, p < 0.001). The feeding artery and side of all 11 SDAVF patients were displayed on TWIST and the results were consistent with DSA. For PAVF patients, the feeding artery in two patients and the sides as displayed on TWIST were consistent with DSA.Conclusions: TWIST enables the differentiation of the spinal artery and vein and the differential diagnosis of SDAVF and PAVF.

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Spinal Dural Arteriovenous Fistula: Diagnosis and Treatment

Neurologico Spinale Medico Chirurgico ◽

10.15562/nsmc.v1i2.75 ◽

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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Paraplegia after contrast media application: a transient or devastating rare complication? Case report

Journal of Neurosurgery Spine ◽

10.3171/2015.5.spine15114 ◽

2016 ◽

Vol 24 (5) ◽

pp. 806-809 ◽

Cited By ~ 5

Author(s):

Dorothee Mielke ◽

Kai Kallenberg ◽

Marius Hartmann ◽

Veit Rohde

Keyword(s):

Spinal Cord ◽

Case Report ◽

Contrast Media ◽

Arteriovenous Fistula ◽

Digital Subtraction Angiography ◽

Dural Arteriovenous Fistula ◽

Rare Complication ◽

Digital Subtraction ◽

Spinal Dural Arteriovenous Fistula ◽

The Individual

The authors report the case of a 76-year-old man with a spinal dural arteriovenous fistula. The patient suffered from sudden repeated reversible paraplegia after spinal digital subtraction angiography as well as CT angiography. Neurotoxicity of contrast media (CM) is the most probable cause for this repeated short-lasting paraplegia. Intolerance to toxicity of CM to the vulnerable spinal cord is rare, and probably depends on the individual patient. This phenomenon is transient and can occur after both intraarterial and intravenous CM application.

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Spinal dural arteriovenous fistula presented with rapidly progressive myelopathy, longitudinally extensive spinal cord lesion, pleocytosis with polymorphonuclear predominance, and decreased cerebrospinal fluid glucose levels: a case report

Rinsho Shinkeigaku ◽

10.5692/clinicalneurol.cn-001472 ◽

2020 ◽

Vol 60 (10) ◽

pp. 699-705

Author(s):

Yuki Kitazaki ◽

Asako Ueno ◽

Kenichiro Maeda ◽

Rei Asano ◽

Shiro Miyayama ◽

...

Keyword(s):

Spinal Cord ◽

Cerebrospinal Fluid ◽

Case Report ◽

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Spinal Cord Lesion ◽

Spinal Dural Arteriovenous Fistula ◽

Glucose Levels ◽

Progressive Myelopathy ◽

Cord Lesion

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Spinal Dural Arteriovenous Fistula with an Associated Feeding Artery Aneurysm: Case Report

Neurosurgery ◽

10.1097/00006123-199904000-00115 ◽

1999 ◽

Vol 44 (4) ◽

pp. 880-880

Author(s):

Paul W. Detwiler ◽

Randall W. Porter ◽

Robert F. Spetzler

Keyword(s):

Case Report ◽

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Artery Aneurysm ◽

Feeding Artery ◽

Spinal Dural Arteriovenous Fistula

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Spinal dural arteriovenous fistula associated with a spinal perimedullary fistula

Journal of Neurosurgery Spine ◽

10.3171/spi.2006.4.3.241 ◽

2006 ◽

Vol 4 (3) ◽

pp. 241-245 ◽

Cited By ~ 20

Author(s):

Timo Krings ◽

Volker A. Coenen ◽

Martin Weinzierl ◽

Marcus H. T. Reinges ◽

Michael Mull ◽

...

Keyword(s):

Spinal Cord ◽

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Vascular Malformations ◽

Venous Drainage ◽

Elevated Pressure ◽

Spinal Dural Arteriovenous Fistula ◽

Arteriovenous Fistulas ◽

Progressive Myelopathy ◽

Dural Arteriovenous Fistulas

✓ Among spinal cord vascular malformations, dural arteriovenous fistulas (DAVFs) must be distinguished from intradural malformations. The concurrence of both is extremely rare. The authors report the case of a 35-year-old man who suffered from progressive myelopathy and who harbored both a DAVF and an intradural perimedullary fistula. During surgery, both fistulas were identified, confirmed, and subsequently obliterated. The fistulas were located at two levels directly adjacent to each other. Although the incidence of concurrent spinal DAVFs is presumed to be approximately 2%, the combination of a dural and an intradural fistula is exceedingly rare; only two other cases have been reported in the literature. One can speculate whether the alteration in venous drainage caused by the (presumably congenital) perimedullary fistula could possibly promote the production of a second dural fistula due to elevated pressure with concomitant venous stagnation and subsequent thrombosis. The authors conclude that despite the rarity of dual pathological entities, the clinician should be aware of the possibility of the concurrence of more than one spinal fistula in the same patient.

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

Journal of Neurosurgery Spine ◽

10.3171/spi-07/08/215 ◽

2007 ◽

Vol 7 (2) ◽

pp. 215-220 ◽

Cited By ~ 11

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.

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Foix-Alajouanine syndrome mimicking a spinal cord tumor

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.63.07.564 ◽

2017 ◽

Vol 63 (7) ◽

pp. 564-565

Author(s):

Renan Salomão ◽

Nathalie Henriques Silva Canêdo ◽

Guilherme P. Abrão ◽

Carlos Lima ◽

Marcus André Acioly

Keyword(s):

Spinal Cord ◽

Arteriovenous Fistula ◽

Rare Disease ◽

Dural Arteriovenous Fistula ◽

Spinal Cord Tumor ◽

Neurological Dysfunction ◽

Diagnostic Challenge ◽

Spinal Dural Arteriovenous Fistula ◽

Necrotizing Myelopathy ◽

Proper Diagnosis

Summary Subacute necrotizing myelopathy (SNM) or Foix-Alajouanine syndrome is a rare disease characterized by progressive neurological dysfunction caused by a spinal dural arteriovenous fistula (AVF). Radiological diagnosis is usually suspected when there is intramedullary nonspecific enhancement and perimedullary flow voids. Ring-enhancement is rarely reported in the scope of AVF, which poses a diagnostic challenge and raises the suspicion of a spinal cord tumor. In such situations, biopsy can be required and delay proper diagnosis. We report the case of a patient with SNM, who underwent biopsy on the assumption of it being a spinal cord tumor.

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

Case Reports in Neurology ◽

10.1159/000521030 ◽

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.

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