Dural arteriovenous fistula in the brain

young stroke toolbox Vascular abnormality of the brain Dural arteriovenous fistula in the brain

What is a dural arteriovenous fistula? DAVF

A dural arteriovenous fistula (DAVF) is a direct connection between an artery and a vein in the dura mater (dura). There is an increased pressure in the efferent vein. read more

What is a dural arteriovenous fistula? DAVF

A dural arteriovenous fistula (DAVF) is a direct connection between an artery and a vein in the dura mater (dura). There is an increased pressure in the efferent vein.

Cause and formation

Little is known about the cause of a DAVF. Usually it is not congenital and occurs over the course of life. A DAVF is more common after a brain trauma, infection, brain surgery, or other brain disorders.

How common is a DAVF?

A DAVF is quite rare. It is unclear how many people have a DAVF in the brain. Every year, 1 in 10 million people are diagnosed with a DAVF.
Symptoms
Complaints from a DAVF in the head are often tinnitus, pressure on the eyes, or a hemorrhage, causing immediate symptoms of loss of function or loss of consciousness.

Tests and diagnosis

An angiography (X-ray of the blood vessels) is required to find and map out the fistula. The images from the examination are discussed with the neurologist and radiologist specializing in the neurovascular system. The attending physician will discuss with you at the outpatient clinic what the best treatment is. When the damage to the nerve tissue is worsening, this is a reason for accelerated diagnostics and possible treatment.

Life with a DAVF

After a DAVF, there are a number of things to consider. read more

Life with a DAVF

When a DAVF is discovered, there is often uncertainty about activities that increase the pressure on the head. Examples include flying, diving, going on a roller coaster, pushing, going to the sauna, or having sex. There is no evidence that these activities increase the risk of a hemorrhage from a DAVF. These activities can therefore be carried out as usual.
It is possible that a DAVF in the brain causes a slightly increased risk of bleeding during pregnancy. If you want to have a child, it is good to discuss with your doctor whether this is a reason to treat the DAVF.
A DVAF in the brain is not hereditary.
There are legal requirements for the suitability of driving motor vehicles according to the “requirements for fitness to drive” regulation of the health inspection. The CBR (Dutch Central Driving License Office) supervises compliance with this requirement.
If you have a DAVF with no symptoms that has not bled, there are no restrictions on the use of motor vehicles.
If the symptoms of the DAVF affect your ability to drive, your specialist will need to make a report about this. On the basis of this report, the Dutch central driver licensing office (CBR) can decide whether an additional independent medical examination or a driving test is required. Your medical specialist will write the report in addition to the CBR's declaration of health (website in Dutch).
In the case of epilepsy as a result of a DAVF, you can be declared fit to drive for a specific period after the end of a seizure-free period. The duration of the seizure-free period depends on several factors. Discuss with your specialist what applies to you.

A DAVF hemorrhage

The first symptom of a DAVF is unfortunately often a brain hemorrhage, a form of stroke. read more

A DAVF hemorrhage

About the hemorrhage

The first symptom of a DAVF is unfortunately often a brain hemorrhage, a form of stroke. The vessel wall of a vein stretches due to high pressure. Some vessels become wider as a result and weak spots appear in the vascular wall. A tear in the vascular wall causes a brain hemorrhage. Hemorrhages from a DAVF can occur at any age. These hemorrhages usually occur in the brain tissue (intracerebral horrhage), but sometimes between the meninges too (subarachnoid hemorrhage). The consequences of the hemorrhage depend on the place of the bleeding in the brain and the size of the bleeding.

Symptoms

The symptoms of hemorrhages vary from just sudden headaches to paralysis, unconsciousness, or an epileptic seizure. In case of a severe hemorrhage, even death can be caused by the hemorrhage or its or its consequences.

Hospitalization after a hemorrhage due to DAVF

Your recovery after hemorrhaging from a DAVF depends on several factors and usually takes many months. If, after the hemorrhage, you experience symptoms of loss of consciousness that limit your ability to think or take care of yourself, then the rehabilitation doctor will assess where you can best recover. This can be done at home, at a rehabilitation center, or in a recovery ward in a nursing home. Depending on your problems, you will be accompanied by physiotherapists, speech therapists, occupational therapists, and social workers.
In order to keep you and your loved ones informed of progress, weekly interviews will be organized with you, your medical team, and your loved ones during the hospitalization. During your admission after the hemorrhage, we will discuss a treatment plan with you and your loved ones.

Complaints

You may continue to have complaints that are both apparent and less apparent to others. Common examples of this are: fatigue, problems with processing stimuli, concentration problems, forgetfulness, and headaches. This can be quite a constraint on picking up your daily life again.
The nurse specialist will discuss follow-up appointments, advice on life rules, and taking up activities with you and your loved ones before being discharged.
Daily activities after a DAVF hemorrhage

After a DAVF hemorrhage, recovery from the hemorrhage is usually the first priority. DAVF treatment usually follows at a later stage when your brain has recovered from the hemorrhage. Your attending physician will determine the correct timing of the treatment.
The effects of a brain hemorrhage on resuming your daily life vary widely, depending on the severity of the hemorrhage. You will receive advice on how to resume your daily activities, work and hobbies from the nursing specialist, rehabilitation doctor, and/or company doctor.
If you are recovering from the hemorrhage, possibly while waiting for the treatment of the DAVF, there is often uncertainty about activities that increase the pressure on the head. Examples include flying, diving, going on a roller coaster, pushing, going to the sauna, or having sex. There is no evidence that these activities increase the risk of new bleeding from a DAVF. These activities can therefore be carried out as usual.

Driving after a DAVF hemorrhage

If the DAVF has hemorrhaged, a driving suspension of 6 months after the hemorrhage applies. If, after this period, there are any residual symptoms that affect driving skills, a report from your specialist will be required. On the basis of this report, the CBR (Dutch Central Driving License Office) can decide whether an additional independent medical examination or a driving test is required. Your medical specialist will write the report in addition to the CBR's declaration of health (website in Dutch).

Survivor stories Cees

"In the time between the hemorrhage and the treatment, I had my doubts and many fears. However, I had no choice: either move on with my life or wait for the next hemorrhage." read more

Survivor stories Cees

My name is Cees, I am 65 years old and live in Doetinchem. I have been happily married to NeIIy for 42 years and together we have 2 children, who are also married and we have 5 beautiful children, including one twin. I have worked 45 years as a process operator in the paper industry. My hobbies are amateur radio broadcasting, which means making contact with other radio amateurs worldwide over short-wave radio, and fishing.

1 When did you have a brain hemorrhage?

In August 2016 I had a brain hemorrhage from a dural AV fistula, which brought me to the Neurosurgery Department. I spent a total of 3.5 weeks there.

2 How did your treatment go?

I cannot remember anything from the first 14 days until a cerebral fluid drain was placed. After that, a long recovery started. In March 2017, I had surgery on that fistula and a clip was placed around that vein.

3 What impact did the brain hemorrhage have on your life?

The whole period has had a big impact on my life. In the time between the hemorrhage and the treatment, I had my doubts and many fears. However, I had no choice: either move on with my life or wait for the next hemorrhage.

4 How did your recovery go?

The first period after the hemorrhage, I had to deal a lot with balance disorder. For example, I fell over with the slightest push. I had to learn to ride a bike again, really by trial and error. I was also very tired, which meant that I was no longer able to do my job. Sleeping two or three times a day was quite normal at that time and if you work in shifts, then you have a problem. That is why I was rejected for work.
I went through a long recovery process after the hemorrhage. At the moment, the brain hemorrhage does not bother me much anymore. Only when I am very tired does the balance disorder come into play, but to a lesser extent than before.

5 How did you experience the care?

All in all, I have to thank the Neurosurgery Department and the doctors for the good care and support I have received during and after my stay there.