Introduction: Dural arteriovenous fistulae (DAVF) occasionally lead to cognitive disorders whose reversibility after DAVF treatment remains unclear. We studied changes on pre- and post-treatment magnetic resonance imaging (MRI) and single photon emission computed tomography (SPECT) scans in ten patients with cognitive disorder due to DAVF.
Methods: We studied the symptoms, pre- and post-treatment MRI scans, SPECT findings, and mini-mental state examination (MMSE) and treatment results in ten patients with cognitive disorder due to DAVF. They were divided into two groups; the post-treatment MMSE score exceeded 25 points in group 1 (n = 6) and was lower than 24 points in group 2 (n = 4).
Results: In the six group 1 patients, pretreatment diffusion-weighted images (DWI) showed hyperintense areas, and SPECT scans demonstrated the preservation of vasoreactivity after acetazolamide challenge. In the four group 2 patients, pretreatment SPECT demonstrated hypoperfusion areas that coincided with the hyperintense areas seen on DWI; there were areas with marked disturbance in vasoreactivity. The post-treatment MMSE score in groups 1 and 2 improved by 13.7 +/- 2.4 and 3.8 +/- 1.0 points, respectively; the difference was significant at p < 0.01.
Conclusion: In patients with cognitive disorder due to DAVF, the preservation of vasoreactivity on SPECT after acetazolamide challenge indicates that their cognitive disorder may be reversible by DAVF treatment.
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