Natural history of dural arteriovenous shunts.
OBJECTIVE
Dural arteriovenous shunts with cortical venous reflux or drainage may cause neurological symptoms and death with or without intracranial hemorrhage. Present knowledge about the natural history of these lesions is limited, however. We investigated the incidences of intracranial hemorrhage, progressive dementia syndrome, and death in patients diagnosed in our neurovascular center.


METHODS
We evaluated the records of 85 patients with dural arteriovenous shunts with cortical venous drainage or reflux hospitalized in our institution from 1978 to 2007. The annual incidences of intracranial hemorrhage, progressive dementia syndrome, and death were calculated.


RESULTS
Fifty-three patients did not have an intracranial hemorrhage as the presenting event. One of these patients bled after diagnosis. Thirty-two patients had an intracranial hemorrhage as the presenting event. Three patients bled after diagnosis. One of these patients died. Apart from deficits caused by hemorrhage, no patient reported adverse neurological symptoms. In patients presenting with an intracranial hemorrhage the annual risk for hemorrhage is approximately 7.4% and in those not presenting with a hemorrhage it is approximately 1.5%.


CONCLUSIONS
The risk of intracranial hemorrhage from a dural arteriovenous shunt with cortical venous drainage is most likely smaller than previously proposed. Presentation with hemorrhage is a risk factor for hemorrhage. The risks of developing neurological symptoms not related to hemorrhage are also less than previously reported.
Söderman
Michael
M
Department of Neuroradiology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden. michael.soderman@karolinska.se
Pavic
Ladislav
L
Edner
Göran
G
Holmin
Staffan
S
Andersson
Tommy
T
D000328:Adult; D000368:Aged; D020785:Central Nervous System Vascular Malformations / Q000453:epidemiology* / Q000503:physiopathology; D002536:Cerebral Arteries / Q000002:abnormalities / Q000503:physiopathology; D002550:Cerebral Veins / Q000002:abnormalities / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000502:physiology; D015897:Comorbidity; D003392:Cranial Sinuses / Q000002:abnormalities / Q000503:physiopathology; D003704:Dementia / Q000453:epidemiology* / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000453:epidemiology* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed