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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
  1. Abbreviations: MRC Medical research council, MRS Modified Rankin Scale, LL lower limbs, UL upper limbs, SAVF spinal arteriovenous fistula, SDAVF spinal dural arteriovenous fistula