Table 1 Clinical characteristics, chronology of events and outcome of patients
From: Clinical heterogeneity of low flow spinal arteriovenous fistulas; a case series
Patient | 1 | 2 | 3 | 4 |
|---|---|---|---|---|
Age at presentation (years) | 50 | 45 | 27 | 56 |
Sex | Male | Male | Male | Male |
Symptoms onset to presentation | 3 months | 1 day | 2 weeks | 5 months |
Presentation | Numbness and weakness of both LL | Numbness and weakness of both LL | Numbness and weakness of both LL | Acute urinary retention, back pain, numbness and weakness of LL |
Antecedent event | None | Haemorrhoid surgery | None | None |
Clinical deficits on presentation | ||||
Motor deficit | LL spastic paraparesis MRC 3 | LL spastic paraparesis MRC 1 | LL spastic paraplegia MRC 4 | LL spastic paraparesis MRC 3 |
Sensory level | T6 | L1 | T12 | L4 |
Bladder involvement | Yes | Yes | Yes | Yes |
Bowel involvement | Yes | No | Yes | No |
Clinical deficits at maximum severity | ||||
Motor score (MRC) | MRC 0/5 | MRC 0/5 | MRC 0/5 | MRC 0/5 |
Functional score (MRS) | MRS 5 | MRS 4 | MRS 3 | MRS 4 |
MRI scan findings | ||||
Spinal cord regions | Craniocervical | Mid thoracic to upper lumbar | Mid thoracic to upper lumbar | Mid thoracic to upper lumbar |
Abnormal signals | Intramedullary hyperintensities extending from the medulla to the C7 cord | Intramedullary T2/FLAIR hyperintensity extending from T6 to L2 | Intramedullary T2/Flair hyperintensity from T7 to L1 | Intramedullary T2 hyperintensity from T6 to L1 with contrast enhancement |
MRI scan findings on maximum disease severity | Centrally hyperintense lesion extending from the pons down to T1 with cord expansion. Anterior serpinginous flow void signals at the upper cervical region | Intramedullary T2/Flair hyperintense lesion from T6 up to L2 with cord expansion and minimal contrast enhancement | Intramedullary T2/FLAIR hyperintense lesion with patchy enhancement extending from T7 to L1 spinal cord | Intramedullary T2 hyperintensity from T4 cord to the conus medullaris with dilated spinal veins seen most prominently from T10 to L1 |
Spinal angiogram | Dural fistula at left C1 level with a likely feeding artery from meningeal branch of left vertebral artery | Suspicious spinal dural arteriovenous fistula (SDAVF) at the L2 region | Dural fistula at left L2 lumbar artery | Initial negative but repeated showed SAVF from left 12th posterior intercostal arteries and L1 lumbar artery |
Response to steroid | Paradoxical worsening | Improvement | Partial response initially with paradoxical worsening | Paradoxical worsening |
Outcome after embolisation | No improvement | No improvement | Improvement | No improvement |
Motor score (MRC) | LL MRC 0 UL MRC 4 | LL MRC 0 UL MRC 5 | LL MRC 4 | LL MRC 1 |
Functional score (MRS) | MRS 4 | MRS 4 | MRS1 | MRS 4 |