Document Detail


Curable cause of paraplegia: spinal dural arteriovenous fistulae.
MedLine Citation:
PMID:  18635837     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: The rarity of spinal dural arteriovenous fistulae makes physicians often overlook this potential diagnosis in patients with progressive gait disturbance and paraparesis. Consequently, patients with spinal dural arteriovenous fistulae can gradually become completely paraplegic if the final diagnosis is delayed considerably. The objective of the current study is to demonstrate that, particularly in patients with paraplegia, surgical treatment of fistula is necessary and often has a favorable outcome. METHODS: Of 42 patients with spinal dural arteriovenous fistulae treated in our institution (surgery or endovascular treatment), 6 were paraplegic preoperatively (Grade IV on the McCormick scale and Grade V on the Aminoff scale, Grade 5 of modified Rankin Scale with motor ASIA between 0 and 10 for both lower limbs). Their clinical history revealed that paraplegia appeared progressively within a period of <3 months. All patients were clinically evaluated at 6 weeks, 6 months, and then annually during an average follow-up of 3 years. Patients received at least one spinal angiography and MRI test during the follow-up period. RESULTS: Total exclusion of the fistula was performed surgically in all cases and was confirmed by spinal angiography. No surgical complications were recorded. All patients improved postoperatively. Three patients showed almost normal walking (Grade I on the McCormick scale, I on the Aminoff scale, Grade 1 of modified Rankin Scale) and 3 were able to walk with a cane (Grade II on McCormick, Grade III on Aminoff scale, Grade 2 of modified Rankin Scale). MRI tests were normal in all patients. CONCLUSIONS: Our results indicate that treatment of fistula is a necessary intervention, even in patients with complete paraplegia.
Authors:
Nozar Aghakhani; Fabrice Parker; Philippe David; Pierre Lasjaunias; Marc Tadie
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Publication Detail:
Type:  Journal Article     Date:  2008-07-17
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  39     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-09-30     Completed Date:  2008-10-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2756-9     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, Bicêtre University Hospital, Le Kremlin-Bicetre, France. Nozar.aghakhani@bct.aphp.fr
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MeSH Terms
Descriptor/Qualifier:
Aged
Central Nervous System Vascular Malformations / complications*,  surgery*
Female
Humans
Male
Middle Aged
Neurosurgical Procedures
Paraplegia / etiology*,  surgery*
Recovery of Function
Spinal Cord / blood supply,  surgery*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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