title: Spinal dural arteriovenous fistulae--a diagnostic challenge.
abstract: BACKGROUND
  Spinal dural arteriovenous fistulae comprise the majority of spinal vascular malformations. The most common clinical presentation is that of progressive myeloradiculopathy, probably related to venous hypertension, which may lead to permanent disability and even death.
  
  
  OBJECTIVE
  To report our clinical experience with spinal dural arteriovenous fistulae.
  
  
  METHODS
  Nine patients with spinal dural AVF were managed at our center during a one year period (1998-1999). The patients, eight men and one woman ranging in age from 46 to 75 years, presented with initially fluctuating and eventually permanent and progressive paraparesis, sensory disturbances and sphincter dysfunction. The neurological signs generally began symmetrically and progressed from the distal to proximal limb regions. The duration of symptoms before diagnosis ranged from 6 to 36 months during which the patients underwent an extensive but fruitless work-up and even unnecessary operations due to misdiagnosis. All patients finally underwent magnetic resonance imaging and spinal angiography, which demonstrated the pathological vascular fistula. Interruption of the AVF was achieved by embolization or by surgical resection.
  
  
  RESULTS
  Following treatment, six patients experienced improvement of gait and sphincter control, and the severe neurological deficits stabilized in the other three patients with long duration of illness. There was no further deterioration in any of the treated patients.
  
  
  CONCLUSIONS
  The history, neurological findings and radiological changes on MRI scan should alert clinicians to the possibility of spinal dural AVF, leading to diagnostic spinal angiography. Early diagnosis and treatment may significantly improve outcome and prevent permanent disability and even mortality.
authors.affiliation: Department of Neurology, Rabin Medical Center (Beilinson Campus), Petah Tiqva, Israel. niril@hotmail.com
authors.forename: N
authors.initials: N
authors.lastname: Lev
authors.forename: S
authors.initials: S
authors.lastname: Maimon
authors.forename: Z H
authors.initials: ZH
authors.lastname: Rappaport
authors.forename: E
authors.initials: E
authors.lastname: Melamed
mesh_terms: D000368:Aged; D020785:Central Nervous System Vascular Malformations / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D004621:Embolization, Therapeutic; D005242:Fecal Incontinence / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020335:Paraparesis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D012678:Sensation Disorders / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D013122:Spinal Diseases / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000175:diagnosis / Q000209:etiology / Q000628:therapy