Reversibility of cognitive disorder after treatment of dural arteriovenous fistulae.
BACKGROUND
Dural arteriovenous fistulae (DAVF) occasionally lead to cognitive disorders whose reversibility after DAVF treatment remains unclear. We studied changes on pre- and post-treatment magnetic resonance imaging (MRI) and single photon emission computed tomography (SPECT) scans in ten patients with cognitive disorder due to DAVF.


METHODS
We studied the symptoms, pre- and post-treatment MRI scans, SPECT findings, and mini-mental state examination (MMSE) and treatment results in ten patients with cognitive disorder due to DAVF. They were divided into two groups; the post-treatment MMSE score exceeded 25 points in group 1 (n = 6) and was lower than 24 points in group 2 (n = 4).


RESULTS
In the six group 1 patients, pretreatment diffusion-weighted images (DWI) showed hyperintense areas, and SPECT scans demonstrated the preservation of vasoreactivity after acetazolamide challenge. In the four group 2 patients, pretreatment SPECT demonstrated hypoperfusion areas that coincided with the hyperintense areas seen on DWI; there were areas with marked disturbance in vasoreactivity. The post-treatment MMSE score in groups 1 and 2 improved by 13.7 +/- 2.4 and 3.8 +/- 1.0 points, respectively; the difference was significant at p < 0.01.


CONCLUSIONS
In patients with cognitive disorder due to DAVF, the preservation of vasoreactivity on SPECT after acetazolamide challenge indicates that their cognitive disorder may be reversible by DAVF treatment.
Kai
Yutaka
Y
Department of Neurosurgery, Graduate School of Medical Sciences, Ryukyu University, Okinawa, Japan. ykai@med.u-ryukyu.ac.jp
Ito
Koichi
K
Kinjo
Tatsuya
T
Hokama
Youhei
Y
Nagamine
Hideki
H
Kushi
Sukemitsu
S
Kinjo
Shigemasa
S
Tsuchida
Yukihiro
Y
Sugimoto
Kouichi
K
Morioka
Motohiro
M
Yano
Shigetoshi
S
Ohmori
Yuki
Y
Kawano
Takayuki
T
Nakamura
Hideo
H
Makino
Keishi
K
Hamada
Jun-ichiro
J
Kuratsu
Jun-ichi
J
Yoshii
Yoshihiko
Y
D000086:Acetazolamide; D000368:Aged; D001921:Brain / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology*; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy*; D002533:Cerebral Angiography; D003072:Cognition Disorders / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
D000086:Acetazolamide
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