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Intracranial Subarachnoid Haemorrhage Caused by Cervical Spinal Dural Arteriovenous Fistulas: Case Report.

ABSTRACT: Cervical spinal vascular abnormalities commonly present with progressive myelopathy as a result of venous congestion. They are not very prone to bleed and tend to be underdiagnosed due to their subtle clinical presentation. We came across a rare case of intracranial subarachnoid haemorrhage caused by cervical spinal dural fistula in the Imperial College Healthcare NHS Trust Hospitals/UK in June 2020. We diagnosed the patient under strict evidence base medicine guidance, which otherwise would have been missed. We discussed the case in several multidisciplinary team (MDT) meetings, and patient was treated under the joint care of the neurology and neurosurgical teams. Patient made a full recovery and discharged home with no neurological defects or complications. Here, we reported this case with all the evidence we gathered from our MDT discussion. We hope our experience would help improve the diagnosis and management protocol for future patients with a similar condition.

SUBMITTER: Zhao J

PROVIDER: S-EPMC8383207 | biostudies-literature | 2021

REPOSITORIES: biostudies-literature

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Intracranial Subarachnoid Haemorrhage Caused by Cervical Spinal Dural Arteriovenous Fistulas: Case Report.

Zhao Junjie J Esemen Yagmur Y Rane Neil N Nair Ramesh R

Frontiers in neurology 20210810

Cervical spinal vascular abnormalities commonly present with progressive myelopathy as a result of venous congestion. They are not very prone to bleed and tend to be underdiagnosed due to their subtle clinical presentation. We came across a rare case of intracranial subarachnoid haemorrhage caused by cervical spinal dural fistula in the Imperial College Healthcare NHS Trust Hospitals/UK in June 2020. We diagnosed the patient under strict evidence base medicine guidance, which otherwise would hav ...[more]

PMID: 34447345

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Project description:Background and purposeA minority of intracranial dural arteriovenous fistulas progress with time. We sought to determine features that predict progression and define outcomes of patients with progressive dural arteriovenous fistulas.Materials and methodsWe performed a retrospective imaging and clinical record review of patients with intracranial dural arteriovenous fistula evaluated at our hospital.ResultsOf 579 patients with intracranial dural arteriovenous fistulas, 545 had 1 fistula (mean age, 45 ± 23 years) and 34 (5.9%) had enlarging, de novo, multiple, or recurrent fistulas (mean age, 53 ± 20 years; P = .11). Among these 34 patients, 19 had progressive dural arteriovenous fistulas with de novo fistulas or fistula enlargement with time (mean age, 36 ± 25 years; progressive group) and 15 had multiple or recurrent but nonprogressive fistulas (mean age, 57 ± 13 years; P = .0059, nonprogressive group). Whereas all 6 children had fistula progression, only 13/28 adults (P = .020) progressed. Angioarchitectural correlates to chronically elevated intracranial venous pressures, including venous sinus dilation (41% versus 7%, P = .045) and pseudophlebitic cortical venous pattern (P = .048), were more common in patients with progressive disease than in those without progression. Patients with progressive disease received more treatments than those without progression (median, 5 versus 3; P = .0068), but as a group, they did not demonstrate worse clinical outcomes (median mRS, 1 and 1; P = .39). However, 3 young patients died from intracranial venous hypertension and intracranial hemorrhage related to progression of their fistulas despite extensive endovascular, surgical, and radiosurgical treatments.ConclusionsFew patients with dural arteriovenous fistulas follow an aggressive, progressive clinical course despite treatment. Younger age at initial presentation and angioarchitectural correlates to venous hypertension may help identify these patients prospectively.

Project description:BackgroundDural 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. In a 10-year single institution experience, clinical presentation of dural arteriovenous fistulas, and in particular headache and angiographic features, as well as long-term outcome were analyzed.MethodsData of 42 intracranial dural arteriovenous fistulas of 40 patients concerning demographic characteristics, medical history and risk factors, clinical presentation and headache features, location and neuroimaging findings, as well as treatment and outcome, were collected. Furthermore, we used the modified-Rankin Scale to assess the long-term outcome, by telephone contact with patients and/or their relatives.ResultsPatients aged between 25 and 89 years (mean age 55.8 ± 15.5). According to different clinical presentation and evolution, related to their unique drainage pattern into the cavernous sinus, we examined the carotid-cavernous fistulas separately from other dural arteriovenous fistulas. 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). Moreover, ocular symptoms were more frequently observed in carotid-cavernous fistulas (92.9% p < 0.001). Seventy percent of patients did not report any impact on quality of life (mRS 0 or 1) at follow-up.ConclusionsThese 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 suggests other dural arteriovenous fistulas. This study provides new significant insights on headache and its characteristics as a presentation symptom in dural arteriovenous fistulas.

Dataset Information

Intracranial Subarachnoid Haemorrhage Caused by Cervical Spinal Dural Arteriovenous Fistulas: Case Report.

Publications

Intracranial Subarachnoid Haemorrhage Caused by Cervical Spinal Dural Arteriovenous Fistulas: Case Report.

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