Document Detail


Myelopathy due to intracranial dural arteriovenous fistulas draining intrathecally into spinal medullary veins. Report of three cases.
MedLine Citation:
PMID:  3193199     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Arteriovenous malformations (AVM's) of the spine commonly cause progressive myelopathy. Occasionally, myelography reveals serpentine filling defects characteristic of a spinal AVM, but an AVM or arteriovenous (AV) fistula cannot be demonstrated arteriographically, despite selective catheterization of all vessels known to have the potential of supplying the spinal cord and spinal dura. Often, and particularly in the setting of subacute or acute deterioration, this has been attributed to spontaneous thrombosis of the veins (the Foix-Alajouanine syndrome). Three patients are reported in whom intracranial dural AV fistulas, supplied by branches of the internal and external carotid arteries, drained into spinal veins and produced myelopathy. In one patient, motor and sensory deficits were limited to the lower extremities. In all three patients, disconnection of the fistula from its spinal venous drainage permitted arrest of a rapidly progressive myelopathy and partial recovery. These findings indicate that some patients who appear to have spinal cord AVM's but exhibit negative spinal arteriography are suffering from cranial dural AV fistulas and therefore need carotid as well as spinal arteriography. The considerable distance of these fistulas from the level of neurological expression supports venous hypertension as a pathophysiological mechanism of spinal cord injury. Interruption of a cranial dural fistula draining into spinal veins permits recovery of the myelopathy.
Authors:
C J Wrobel; E H Oldfield; G Di Chiro; E C Tarlov; R A Baker; J L Doppman
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  69     ISSN:  0022-3085     ISO Abbreviation:  J. Neurosurg.     Publication Date:  1988 Dec 
Date Detail:
Created Date:  1989-01-10     Completed Date:  1989-01-10     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  934-9     Citation Subset:  AIM; IM    
Affiliation:
Clinical Neurosurgery Section, National Institute of Neurological and Communicative Disorders and Stroke, Bethesda, Maryland.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Arteriovenous Fistula / complications*,  radiography,  surgery
Cerebral Angiography
Cerebral Arteries*
Dura Mater / blood supply*
Humans
Male
Medulla Oblongata / blood supply*
Myelography
Spinal Cord / blood supply*,  radiography
Spinal Cord Diseases / etiology*
Veins

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


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