The spinal dural arteriovenous fistula is a rare condition that occurs especially in middle-aged men. The disease begins with a small passage (fistula) between the artery that supplies the spinal cord and spinal membrane with blood and the vein that carries it off. The passage develops within the spinal membrane at the point where the root emerges. Why this happens is unknown. Because of the passage, the pressure in the veins becomes too high and this reduces the supply of oxygen-rich blood to the spinal cord. This results in increasing damage to the spinal cord, which manifests itself as sensory disorders, gait disorders, and loss of strength in the legs, difficulty urinating, and often in erectile disorders in men. If untreated, the disease can lead to a complete spinal cord lesion. But the disease can be treated, either with an operation or by what is known as glue embolization, in which a catheter is used to close the fistula with a kind of glue. The gait disorders and leg strength often respond better to this treatment than do the urination problems and erectile dysfunction. This disease is difficult to identify and is probably under-diagnosed; diagnosis can be made with procedures that include an MRI of the spinal cord and a catheter test. In Korné Jellema’s view, it is important for neurologists to consider this disease when these symptoms are present.
Korné Jellema
Spinal dural arteriovenous fistulas
PhD advisor: Prof. J. van Gijn
Co-advisor: Dr. C.C. Tijssen