دورية أكاديمية
A case series of intracranial dural arteriovenous fistulae mimicking cervical myelitis : a diagnosis not to be missed
| العنوان: | A case series of intracranial dural arteriovenous fistulae mimicking cervical myelitis : a diagnosis not to be missed |
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| المؤلفون: | Whittam, Daniel, Huda, Saif, Gibbons, Emily, Pullicino, Richard, Solomon, Tom, Chandran, Arun, Puthuran, Mani, Jacob, Anu |
| بيانات النشر: | Springer Medizin |
| سنة النشر: | 2021 |
| المجموعة: | University of Malta: OAR@UM / L-Università ta' Malta |
| مصطلحات موضوعية: | Cerebral arteriovenous malformations -- United Kingdom, Fistula, Arteriovenous, Cerebrovascular disease, Myelitis, Spinal cord -- Wounds and injuries |
| الوصف: | Objective: To describe the diagnostic features of intracranial dural arteriovenous fistulae (DAVF) presenting with cervical cord or brainstem swelling. Methods: Retrospective case note and neuroimaging review of patients with angiographically confirmed DAVF diagnosed during January 2015-June 2020 at a tertiary neuroscience centre (Walton Centre NHS Foundation Trust, Liverpool, UK). Results: Six intracranial DAVF causing cervical cord or brainstem oedema (all males aged 60-69 years) and 27 spinal DAVF (88% thoracolumbar) were detected over a 5.5-year period. Significantly more patients with intracranial DAVF received steroids for presumed inflammatory myelitis than those with spinal DAVF (5/6 vs 1/27, p = 0.0001, Fisher's exact test). Several factors misled the treating clinicians: atypical rostral location of cord oedema (6/6); acute clinical deterioration (4/6); absence (3/6) or failure to recognise (3/6) subtle dilated perimedullary veins on MRI; intramedullary gadolinium enhancement (2/6); and elevated CSF protein (4/5). Acute deterioration followed steroid treatment in 4/5 patients. The following features may suggest DAVF rather than myelitis: older male patients (6/6), symptomatic progression over 4 or more weeks (6/6) and acellular CSF (5/5). Conclusion: Intracranial DAVF are uncommon but often misdiagnosed and treated as myelitis, which can cause life-threatening deterioration. Neurologists must recognise suggestive features and consider angiography, especially in older male patients. Dilated perimedullary veins are an important clue to underlying DAVF, but may be invisible or easily missed on routine MRI sequences. ; peer-reviewed |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | English |
| تدمد: | 14321459 |
| العلاقة: | Whittam, D., Huda, S., Gibbons, E., Pullicino, R., Solomon, T., Chandran, A.,.Jacob, A. (2021). A case series of intracranial dural arteriovenous fistulae mimicking cervical myelitis: a diagnosis not to be missed. Journal of Neurology, 268(12), 4680-4686.; https://www.um.edu.mt/library/oar/handle/123456789/118884Test |
| DOI: | 10.1007/s00415-021-10571-0 |
| الإتاحة: | https://doi.org/10.1007/s00415-021-10571-0Test https://www.um.edu.mt/library/oar/handle/123456789/118884Test |
| حقوق: | info:eu-repo/semantics/openAccess ; The copyright of this work belongs to the author(s)/publisher. The rights of this work are as defined by the appropriate Copyright Legislation or as modified by any successive legislation. Users may access this work and can make use of the information contained in accordance with the Copyright Legislation provided that the author must be properly acknowledged. Further distribution or reproduction in any format is prohibited without the prior permission of the copyright holder. |
| رقم الانضمام: | edsbas.D054A6 |
| قاعدة البيانات: | BASE |
| تدمد: | 14321459 |
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| DOI: | 10.1007/s00415-021-10571-0 |