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Dural Arteriovenous Fistulas
Dural Arteriovenous Fistulas
WHAT IS
DURAL ARTERIOVENOUS FISTULAS?
A DAVF is an abnormal connection between arteries and veins in the dura mater (outer membrane) of the brain. Depending on their size and location, DAVFs can cause headaches, neurological symptoms, or bleeding.
causes
Narrowing or blockage of a brain venous
Traumatic head injury
Infections near the brain
Previous brain surgery or craniotomy
Blood clots in deep veins
Tumors in the meninges
Changes in blood clotting
inflammation and neovascularization
symptoms
Headaches, nausea, and vomiting
Pulsatile tinnitus
Visual disturbances like double vision, eye bulging, swelling, or paralysis of eye muscles
Seizures
Neurological deficits including weakness, numbness, facial pain, and speech problems
Coordination problems and difficulty walking
Symptoms of increased intracranial pressure
Dementia or apathy in severe cases
Burning or prickling sensations
lower back pain, leg numbness or weakness
no symptoms and may be discovered incidentally
sudden headache, neurological deficits, or stroke-like symptoms
if untreated?
Intracranial hemorrhage
Rupture of fragile abnormal vessels can cause bleeding in the brain, including intracerebral hemorrhage, subdural hematomas, or subarachnoid hemorrhage, leading to stroke or death.
Neurological deficits
Progressive damage due to abnormal blood flow and venous hypertension may cause weakness, sensory loss, seizures, speech or vision impairment, ataxia, and cognitive decline.
Increased intracranial pressure
Venous congestion can elevate pressure inside the skull, causing headaches, nausea, vomiting, decreased consciousness, and brain edema.
Spinal cord damage
In spinal DAVFs, untreated lesions can cause progressive myelopathy, gait disturbances, limb weakness, numbness, bladder/bowel dysfunction, and even paralysis.
Seizures and cognitive impairment
Involvement of brain tissue can lead to seizures, dementia, or parkinsonism-like symptoms.
Permanent disability or death
Serious bleeding or irreversible neurological injury may cause permanent disability or be fatal.
Heart failure
Rarely, large fistulas can lead to high-output heart failure by increasing cardiac workload through abnormal shunting.
diagnosis
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Digital Subtraction Angiography (DSA)
Magnetic Resonance Imaging (MRI) and Magnetic Resonance Angiography (MRA)
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Noninvasive imaging methods that can identify dilated vessels, venous congestion, and effects on brain or spinal tissue include magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA).
Computed Tomography (CT) and CT Angiography (CTA)
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Used to evaluate abnormal vasculature, edema, and brain hemorrhage.
Spinal angiography
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Initially suspected by spinal MRI (enlarged, swollen vessels), spinal dAVFs are verified by spinal angiography.
