Document Detail

Recovery from paraplegia after the treatment of spinal dural arteriovenous fistula: case report and review of the literature.
MedLine Citation:
PMID:  19618103     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Spinal dural arteriovenous fistula (SDAVF) is a rare and enigmatic disease. Functional outcome is particularly uncertain for the small group of patients that are unable to stand at the time of diagnosis (grade 5 gait disturbance on the Aminoff-Logue scale, ALS). The objective of this study is to examine the final functional outcome of patients with SDAVF in grade 5 gait ALS before treatment. METHODS: We conducted a PubMed search using the keyword "spinal dural arteriovenous fistula." A review of the clinical series and single well-detailed case reports of SDAVF gathered 106 patients with grade 5 gait ALS on the initial examination. Additionally, we report the case of a 56-year-old man presenting acute paraplegia and urinary retention on admission who had complained of sporadic motor and sphincter disturbances for 1 year. Spine T2-weighted MR imaging showed a central hyperintensity within the spinal cord, and the angiography demonstrated a T-11 SDAVF. Interruption of the fistula was performed through an urgent one-level laminectomy. RESULTS: Grade 5 gait ALS was present in 25% of the patients with SDAVF included in the clinical series. Latest follow-up showed that gait disturbance improved in 73% of patients after treatment, although less than 6% became grade 1 gait ALS. Micturition disturbances improved in 39%. Exploration of our patient showed improvement to grade 1 gait ALS 1 year after the surgical treatment. CONCLUSION: Interruption of SDAVF in paraplegic patients may improve the final functional gait outcome in some cases. No complete recovery (grade 0 gait ALS) was achieved after treatment. Micturition disturbances had a worse prognosis than motor deficits.
Ruth Prieto; Jose M Pascual; Raquel Guti??rrez; Enrique Santos
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Publication Detail:
Type:  Case Reports; Journal Article; Review     Date:  2009-07-18
Journal Detail:
Title:  Acta neurochirurgica     Volume:  151     ISSN:  0942-0940     ISO Abbreviation:  Acta Neurochir (Wien)     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-11-03     Completed Date:  2010-02-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0151000     Medline TA:  Acta Neurochir (Wien)     Country:  Austria    
Other Details:
Languages:  eng     Pagination:  1385-97     Citation Subset:  IM    
Department of Neurosurgery, Clinico San Carlos University Hospital, 28040 Madrid, Spain.
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MeSH Terms
Central Nervous System Vascular Malformations / pathology,  physiopathology*,  surgery
Disease Progression
Gait Disorders, Neurologic / etiology,  physiopathology*,  surgery
Middle Aged
Paraplegia / etiology,  physiopathology*,  surgery
Recovery of Function / physiology
Spinal Cord / pathology,  physiopathology*
Spinal Cord Diseases / pathology,  physiopathology*,  surgery
Treatment Outcome

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