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Neurologic Decline After Spinal Angiography for Dural Arteriovenous Fistula and Improvement with Emergent Surgical Ligation
- Source :
- World Neurosurgery. 92:587.e15-587.e18
- Publication Year :
- 2016
- Publisher :
- Elsevier BV, 2016.
-
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. Case Description 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.
- Subjects :
- Weakness
medicine.medical_specialty
Arteriovenous fistula
Neurosurgical Procedures
03 medical and health sciences
0302 clinical medicine
Dural arteriovenous fistulas
medicine
Humans
030212 general & internal medicine
Neurologic decline
Emergency Treatment
Ligation
Aged
Central Nervous System Vascular Malformations
medicine.diagnostic_test
business.industry
Angiography
medicine.disease
Spinal cord
Surgery
medicine.anatomical_structure
Spinal Cord
Anesthesia
Female
Neurology (clinical)
Nervous System Diseases
medicine.symptom
business
Complication
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 18788750
- Volume :
- 92
- Database :
- OpenAIRE
- Journal :
- World Neurosurgery
- Accession number :
- edsair.doi.dedup.....87cf4f111b40c2332ef98af1b8581224