Steroid-Associated Acute Clinical Worsening and Poor Outcome in Patients With Spinal Dural Arteriovenous Fistulas: A Prospective Cohort Study.
Adult
Aged
Angiography
/ trends
Central Nervous System Vascular Malformations
/ diagnostic imaging
Cohort Studies
Disease Progression
Female
Humans
Longitudinal Studies
Male
Middle Aged
Prospective Studies
Retrospective Studies
Spinal Cord
/ diagnostic imaging
Steroids
/ adverse effects
Treatment Outcome
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
01 Jun 2020
01 Jun 2020
Historique:
pubmed:
11
1
2020
medline:
30
9
2020
entrez:
11
1
2020
Statut:
ppublish
Résumé
A prospective cohort study. We conducted a prospective cohort study to identify the association between steroids and clinical worsening and compare outcomes between patients with and without preoperative steroid administration. Patients with spinal dural arteriovenous fistulas (SDAVFs) often were misdiagnosed and treated with steroids which led to acute worsening. Patients with angiographically confirmed SDAVFs were recruited consecutively between March 2013 and December 2014 in two referral centers. We reviewed the history of all the patients to identify those patients who were treated with steroids before exclusion of the fistulas. Modified Aminoff & Logue scale (mALS) was used to evaluate the spinal cord function at different time points: before and after steroid administration, before operation, and at 1-year follow-up. Paired t tests were used to assess the mALS of patients with steroid administration at different time points. Unpaired t tests and Pearson chi-square test were used to assess differences between patients with and without steroid administration. Eighteen patients with (18.2%) and 81 patients without (81.8%) steroid administration were included in this study. At baseline, there were no difference between both patient groups, in regards to age, sex, duration, location of fistula, treatment, and preoperative mALS. Patients without steroid administration, however, had statistically significant better outcome according to their mALS at 1-year follow-up (P < 0.05). Steroid administration can induce acute clinical worsening in patients with SDAVFs that may persist despite successful obliteration of the fistula and should thus be avoided. 3.
Sections du résumé
STUDY DESIGN
METHODS
A prospective cohort study.
OBJECTIVE
OBJECTIVE
We conducted a prospective cohort study to identify the association between steroids and clinical worsening and compare outcomes between patients with and without preoperative steroid administration.
SUMMARY OF BACKGROUND DATA
BACKGROUND
Patients with spinal dural arteriovenous fistulas (SDAVFs) often were misdiagnosed and treated with steroids which led to acute worsening.
METHODS
METHODS
Patients with angiographically confirmed SDAVFs were recruited consecutively between March 2013 and December 2014 in two referral centers. We reviewed the history of all the patients to identify those patients who were treated with steroids before exclusion of the fistulas. Modified Aminoff & Logue scale (mALS) was used to evaluate the spinal cord function at different time points: before and after steroid administration, before operation, and at 1-year follow-up. Paired t tests were used to assess the mALS of patients with steroid administration at different time points. Unpaired t tests and Pearson chi-square test were used to assess differences between patients with and without steroid administration.
RESULTS
RESULTS
Eighteen patients with (18.2%) and 81 patients without (81.8%) steroid administration were included in this study. At baseline, there were no difference between both patient groups, in regards to age, sex, duration, location of fistula, treatment, and preoperative mALS. Patients without steroid administration, however, had statistically significant better outcome according to their mALS at 1-year follow-up (P < 0.05).
CONCLUSION
CONCLUSIONS
Steroid administration can induce acute clinical worsening in patients with SDAVFs that may persist despite successful obliteration of the fistula and should thus be avoided.
LEVEL OF EVIDENCE
METHODS
3.
Identifiants
pubmed: 31923124
doi: 10.1097/BRS.0000000000003370
pii: 00007632-202006010-00014
doi:
Substances chimiques
Steroids
0
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
E656-E662Références
Kataoka H, Miyamoto S, Nagata I, Ueba T, Hashimoto N. Venous congestion is a major cause of neurological deterioration in spinal arteriovenous malformations. Neurosurgery 2001; 48:1224–1230.
Krings T. Vascular malformations of the spine and spinal cord∗: anatomy, classification, treatment. Clin Neuroradiol 2010; 20:5–24.
Krings T, Mull M, Gilsbach JM, et al. Spinal vascular malformations. Eur Radiol 2005; 15:267–278.
Jellema K, Canta LR, Tijssen CC, Van Rooij WJ, Koudstaal PJ, Van Gijn J, et al. Spinal dural arteriovenous fistulas: clinical features in 80 patients. J Neurol Neurosurg Psychiatry 2003; 74:1438–1440.
O’Keeffe DT, Mikhail MA, Lanzino G, Kallmes DF, Weinshenker BG. Corticosteroid-induced paraplegia-a diagnostic clue for spinal dural arterial venous fistula. JAMA Neurol 2015; 72:833–834.
Strowd RE, Geer C, Powers A, Abou-Zeid N. A unique presentation of a spinal dural arteriovenous fistula exacerbated by steroids. J Clin Neurosci 2012; 19:466–468.
McKeon A, Lindell EP, Atkinson JL, Weinshenker BG, Piepgras DG, Pittock SJ. Pearls & oy-sters: clues for spinal dural arteriovenous fistulae. Neurology 2011; 76:e10–e12.
Cabrera M, Paradas C, Márquez C, González A. Acute paraparesis following intravenous steroid therapy in a case of dural spinal arteriovenous fistula. J Neurol 2008; 255:1432–1433.
Ma Y, Chen S, Peng C, et al. Clinical outcomes and prognostic factors in patients with spinal dural arteriovenous fistulas: a prospective cohort study in two Chinese centres. BMJ Open 2018; 8:e019800.
Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. STROBE InitiativeThe Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007; 370:1453–1457.
Nasr DM, Brinjikji W, Rabinstein AA, Lanzino G. Clinical outcomes following corticosteroid administration in patients with delayed diagnosis of spinal arteriovenous fistulas. J Neurointerv Surg 2017; 9:607–610.
DiSano MA, Cerejo R, Mays M. Acute paraparesis and sensory loss following intravenous corticosteroid administration in a case of longitudinally extensive transverse myelitis caused by spinal dural arteriovenous fistula: case report and review of literature. Spinal Cord Ser Cases 2017; 3:17025.
Noh T, Chandra R, Kim J, Lee I. A case of symptomatic spinal dural arteriovenous fistula after high-volume lumbar puncture. Surg Neurol Int 2017; 8:164.
Garcia-Cabo C, Moris G. Sudden paraplegia after lumbar puncture as a clue in the diagnosis of a patient with spinal dural arteriovenous fistula. Eur Spine J 2017; 26: (suppl 1): 151–153.
Hetts SW, Narvid J, Singh T, et al. Association between lumbar epidural injection and development of acute paraparesis in patients with spinal dural arteriovenous fistulas. AJNR Am J Neuroradiol 2007; 28:581–583.
Owen NC, Smith LT, Massey L, Durnford AJ, Hillier CE. Decompensation of undiagnosed spinal dural arteriovenous fistulae after lumbar epidural injection and spinal anaesthesia. Br J Anaesth 2011; 107:109–111.
Oliver TA, Sorensen M, Arthur AS. Endovascular treatment for acute paraplegia after epidural steroid injection in a patient with spinal dural arteriovenous malformation. J Neurosurg Spine 2012; 17:251–255.
Kim S, Choi Y, Park J, Sung DH. Acute paraplegia after lumbar steroid injection in patients with spinal dural arteriovenous fistulas: case reports. Ann Rehabil Med 2016; 40:949–954.
Sharma K, Sharma VD. Delayed onset paraparesis complicating epidural steroid injection with underlying spinal dural arteriovenous fistula. Pain Manag 2016; 6:421–425.
Annaswamy TM, Worchel J. Paraplegia following lumbar epidural steroid injection in a patient with a spinal dural arteriovenous fistula. Am J Phys Med Rehabil 2017; 96:e147–e150.
Khurana VG, Perez-Terzic CM, Petersen RC, Krauss WE. Singing paraplegia: a distinctive manifestation of a spinal dural arteriovenous fistula. Neurology 2002; 58:1279–1281.
Van Lieshout JJ, Imholz BP, Wesseling KH, Speelman JD, Wieling W. Singing-induced hypotension: a complication of a high spinal cord lesion. Neth J Med 1991; 38:75–79.
Kalsner S. Mechanism of hydrocortisone potentiation of responses to epinephrine and norepinephrine in rabbit aorta. Circ Res 1969; 24:383–395.
Besse JC, Bass AD. Potentiation by hydrocortisone of responses to catecholamines in vascular smooth muscle. J Pharmacol Exp Ther 1966; 154:224–238.
Whitworth JA. Mechanisms of glucocorticoid-induced hypertension. Kidney Int 1987; 31:1213–1224.
Zhang HQ, Chen T, Wu SS, et al. The pathophysiology of venous hypertensive myelopathy--study of an animal model: laboratory investigation. J Neurosurg Spine 2013; 19:485–491.
Takahashi H, Ueshima T, Goto D, et al. Acute tetraparesis with respiratory failure after steroid administration in a patient with a dural arteriovenous fistula at the craniocervical junction: a case report. Intern Med 2018; 57:591–594.