Dural Arteriovenous Fistulas (DAVF)

What are Dural Arteriovenous Fistulas?

Dural arteriovenous fistulas (DAVF) are anomalies caused by an abnormal connection between a vein carrying blood from the brain to the heart and an artery located within the covering of the brain. It can cause veins that typically carry low-pressure arterial blood to carry high-pressure blood instead, which can ultimately lead to a brain hemorrhage or various neurological symptoms.

Fortunately, these anomalies are quite rare. They most often appear in older adult males, although people from both genders and all age groups have been diagnosed with them. DAVFs are often congenital, and most of the time the direct cause is not clear. However, some cases can be linked to surgery, trauma, infection, or tumors. DAVFs can be classified as cranial or spinal.

What are the Symptoms of Dural Arteriovenous Fistulas?

Despite their location outside of the brain, DAVFs often create various symptoms that are neurological in nature. How the patient experiences the condition depends on how the anomaly has formed.

Cranial DAVF symptoms include

  • Ringing in the ear (tinnitus)
  • Abnormal sound connected to turbulent blood flow (bruit)
  • Visual impairment
  • Headache
  • Optic disc swelling (papilledema)
  • Hemorrhage
  • Seizures
  • Bulging eyes (proptosis)
  • Glaucoma
  • Cranial nerve dysfunction
  • Neurological decline
  • Stroke-like symptoms

Spinal DAVF symptoms include

  • Erectile dysfunction
  • Sudden or progressive loss of limb function and sensation
  • Progressive dysfunction of the bladder and bowel

Dural Arteriovenous Fistulas Causes

Dural arteriovenous fistulas is a condition caused by head trauma, surgery, infection, or blood clots in the brain, commonly known as thrombosis, as well as potentially being a congenital disability. If the brain becomes oxygen starved for extended periods of time, brain damage may occur causing dural arteriovenous fistulas. Other common causes of dural arteriovenous fistulas include illnesses or injuries. Also, males ranging from 15 to 24, young children, as well as the elderly are at a higher risk dural arteriovenous fistula.

Other causes of dural arteriovenous fistulas include:

  • Auto accidents
  • Trauma to the head
  • Athletic injuries
  • Trips and falls
  • Violence

Infections also cause dural arteriovenous fistulas, including:

  • Bacterial meningitis
  • Toxoplasmosis (or toxo), a parasite-borne infection transmitted from an infected mother to her child, through eating uncleaned vegetables or undercooked meat, or making direct contact with feline feces.
  • Cerebral cysticercosis which comes from a pork-based tapeworm.

How are Dural Arteriovenous Fistulas Treated?

There is no way to prevent DAVF, but those at risk should be monitored and treated if necessary. Treatment depends on where the anomaly is located, symptom severity, and the risk of developing a hemorrhage. Low-risk cases are occasionally not treated at all, and a doctor will instead instruct the patient to keep track of their condition.

Treatment includes

Other cases may require radiation therapy, gamma knife surgery, or endovascular embolization. If none of the other options are viable or successful, there is a chance the person may need open surgery.

Dural Arteriovenous Fistulas Prevention

The most efficient ways of preventing dural arteriovenous fistulas involve the prevention of injury and infection.

Methods of head injury prevention include:

  • Wearing a seat belt in a vehicle
  • Using a child safety seat or booster seat
  • Never drinking and driving
  • Consistently wearing a helmet when riding a bicycle, scooter, snowmobile, motorcycle, and other types of unrestrained vehicles
  • Wearing a helmet when playing contact sports
  • Wearing a helmet when riding a horse
  • Wearing a helmet while skating, skiing, snowboarding, and skateboarding
  • Using handrails on stairways
  • Installing sufficient lighting, particularly on stairs for those with bad vision or people who have problems walking
  • Putting bars on windows to stop children from falling
  • Clearing obstacles from walking pathways

Because brain infections are commonly caused by a virus and bacterial infections, the most efficient method of preventing a brain infection involves maintaining sanitation standards, good hygiene, washing your hands, optimizing your body’s immune system, and getting an IPD vaccine.