title: Neurologic Decline After Spinal Angiography for Dural Arteriovenous Fistula and Improvement with Emergent Surgical Ligation.
abstract: BACKGROUND
  Although angiography does not generally lead to increased clinically significant neurologic deficits, it has been reported that angiography for spinal dural arteriovenous fistulas (SDAVFs) can lead to acute neurologic decline. This has been rarely reported, and outcome after decline and the subsequent intervention performed have not been clarified. We describe a patient with SDAVF who experienced acute neurologic decline shortly after spinal angiography. Acute surgical treatment resulted in improvement of symptoms.
  
  
  METHODS
  A 70-year-old woman presented following 5 months of progressive numbness and weakness in her lower extremities. Spinal magnetic resonance imaging revealed thoracic spinal cord edema. Spinal angiography revealed a type 1 SDAVF. Several hours after spinal angiography, the patient's lower extremity motor strength declined significantly. This neurologic change led to emergent surgical intervention and ligation of the SDAVF. The patient's neurologic decline subsequently improved and ultimately resolved completely.
  
  
  CONCLUSIONS
  Although acute worsening of neurologic deficits is a rare complication following angiography of SDAVFs, the reversibility of these deficits by emergent intervention argues for careful surveillance after angiography with protocols in place to rapidly intervene if needed. Warming and diluting the contrast agent should be considered to reduce contrast viscosity, a potential aggravating factor to the venous congestion of spinal fistulas.
authors.affiliation: Department of Neurosurgery, University of Texas UT Health Medical System, Houston, Texas, USA.
authors.forename: Abdelrahman
authors.initials: A
authors.lastname: Abdelazim
authors.affiliation: Department of Neurosurgery, University of Texas UT Health Medical System, Houston, Texas, USA.
authors.forename: Cory
authors.initials: C
authors.lastname: Hartman
authors.affiliation: Department of Neurosurgery, University of Texas UT Health Medical System, Houston, Texas, USA.
authors.forename: Kristopher
authors.initials: K
authors.lastname: Hooten
authors.affiliation: Department of Neurosurgery, University of Texas UT Health Medical System, Houston, Texas, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Cutler
authors.affiliation: Department of Neurosurgery, University of Texas UT Health Medical System, Houston, Texas, USA. Electronic address: spiros.blackburn@uth.tmc.edu.
authors.forename: Spiros
authors.initials: S
authors.lastname: Blackburn
mesh_terms: D000368:Aged; D000792:Angiography / Q000009:adverse effects* / Q000379:methods; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging* / Q000601:surgery*; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D006801:Humans; D008026:Ligation; D009422:Nervous System Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D019635:Neurosurgical Procedures / Q000379:methods*; D013116:Spinal Cord / Q000000981:diagnostic imaging
keywords: Angiography; Decline; Dural Arteriovenous Fistula; Spinal