Dural Arteriovenous Fistula Davf

Overview

A dural arteriovenous fistula (DAVF) is a rare blood vessel problem in the dura. The dura is the tough outer covering of the brain and spinal cord. In a DAVF, an artery (a blood vessel that carries blood away from the heart) connects directly to a vein (a blood vessel that carries blood back to the heart) without the tiny capillaries in between. This can change how blood flows and raise pressure in nearby veins. A DAVF is not a tumor. It can be harmless in some people, but in others it can cause serious problems, so specialist care is important.

DAVF is rare. It is an uncommon type of blood vessel problem in and around the brain.

Most people diagnosed with DAVF are adults, often older adults. It can affect anyone, including children, but it is very rare in children. Some people have no clear risk factor.

Symptoms

Common symptoms

• A rhythmic whooshing, swishing, or ringing sound in one ear that matches your heartbeat. This is called pulsatile tinnitus.
• Headaches, which may be constant or come and go.
• Redness, swelling, or a bulging feeling in one eye.
• Blurred vision, double vision, or other vision changes.
• Dizziness or hearing problems.
• Weakness, numbness, or problems moving one side of the body.
• Trouble speaking or understanding speech.
• Seizures.
• Confusion or changes in thinking.
• Some people have no symptoms at all, and the DAVF is found during tests for another reason.

Symptoms in children

• DAVF is very rare in children. When it happens, symptoms can be different from adults.
• In babies, signs may include poor feeding, fast breathing, an unusually large head, or a bulging soft spot on the head.
• In older children, symptoms may include headaches, seizures, weakness, developmental delay, or a whooshing sound in the ear.

Symptoms in older adults

• Older adults may be more likely to notice a whooshing sound in the ear, headaches, or eye symptoms.
• They may also have stroke-like symptoms if the DAVF affects certain veins around the brain.
• Because other health conditions are more common with age, a specialist assessment is important.

Causes

Main causes

• The exact cause of DAVF is often unknown.
• It is thought to develop when veins in the dura become blocked or damaged, and new abnormal connections form between arteries and veins.
• Some cases are linked to a blood clot in a vein around the brain, a head injury, or brain surgery.
• Some DAVFs may be present from birth, but this is uncommon.

Risk factors

• Older age.
• A previous blood clot in a vein around the brain, called venous sinus thrombosis.
• Head injury.
• Brain surgery or other surgery near the head or spine.
• Some genetic or inherited conditions that affect blood vessels, though this is rare.
• Many people with DAVF have no clear risk factor.

When to see a doctor

See a doctor urgently if:

• You notice a new whooshing sound in your ear that matches your heartbeat.
• You have new redness, swelling, or bulging of one eye.
• You have new double vision or other vision changes.
• You have a headache that is getting worse or not getting better with usual care.
• You have a known DAVF and your symptoms change or get worse.

Book a routine appointment if:

• You have a whooshing sound in your ear that has been there for a while.
• You have frequent or unexplained headaches.
• You have a history of a blood clot in a vein around the brain or brain surgery, and you want advice about follow-up.
• You are worried about symptoms and want to talk them through with a doctor.

Diagnosis

A doctor will ask about your symptoms, look at your eyes and nervous system, and arrange imaging tests. DAVF is diagnosed with scans that show how blood flows in and around the brain. In many cases, you will be referred to a specialist team, such as a neurologist, neurosurgeon, or interventional neuroradiologist. An interventional neuroradiologist is a doctor who uses imaging and small tubes to treat blood vessel problems.

Tests that may be done

• CT scan or CT angiogram: a CT scan uses X-rays to make detailed pictures. A CT angiogram uses a dye to show blood vessels.
• MRI or MR angiogram: MRI uses magnets and radio waves to make detailed pictures. An MR angiogram shows blood vessels.
• Catheter cerebral angiogram: this is the most detailed test. A thin tube is guided through blood vessels, often from the groin or arm, and dye is used to take pictures of the blood vessels in the brain. It is done by a specialist.
• Eye examination: an eye doctor may check for pressure or swelling behind the eye.
• Ultrasound: sometimes used to look at blood flow in the neck or around the eye.
• Blood tests may be done to check your general health, but they do not diagnose DAVF.

What to expect at your appointment

You may need more than one test. Some scans use a contrast dye, and your team will ask about allergies and kidney problems first. A catheter angiogram is usually done as a day case or with a short hospital stay. It has small risks, and your specialist will explain them. Waiting for test results can feel stressful, so ask your team when to expect results and who to contact with questions.

Treatment

Treatment depends on where the DAVF is, which veins it drains into, and whether it raises the risk of bleeding or other problems. Some low-risk DAVFs can be watched with regular check-ups. Higher-risk DAVFs are usually treated to close the abnormal connection. A specialist team will explain the options and the benefits and risks for your case.

Self-care at home

• Keep all appointments with your specialist team.
• Take any medicines exactly as prescribed. Do not stop or change them without asking your doctor or pharmacist.
• Keep a note of your symptoms, including when they happen and how long they last.
• Know the emergency warning signs and what to do if they happen.
• Avoid smoking and limit alcohol.
• Ask your doctor about safe levels of physical activity, heavy lifting, or straining.
• Manage other health conditions, such as high blood pressure, with your doctor.

Medical treatments

There is no medicine that can close a DAVF. The main treatments are procedures done by specialists. These include endovascular embolization, where a thin tube is guided through blood vessels to block the abnormal connection; surgery to close or remove the fistula; and focused radiation, sometimes called stereotactic radiosurgery, which slowly closes the abnormal vessels over time. Medicines may be used to help with symptoms such as headaches or high blood pressure, but they do not cure the DAVF.

When is surgery considered?

A procedure may be recommended if the DAVF has features that raise the risk of bleeding, if it is causing serious or worsening symptoms, or if it is affecting vision or brain function. The specialist team will discuss whether embolization, surgery, or radiosurgery is best for you.

Living with this condition

Many people with DAVF see a specialist team for regular check-ups. Keep track of any new symptoms and ask your team about activity limits. If you have a low-risk DAVF that is being watched, you may not need treatment, but you still need follow-up. If you have had treatment, follow your team's advice about recovery and when you can return to work, driving, or exercise.

Lifestyle tips

• Do not smoke. Ask your doctor or pharmacist for help to stop if needed.
• Limit alcohol.
• Eat a heart-healthy diet.
• Stay physically active as advised by your doctor.
• Get enough sleep and manage stress where possible.
• Ask your doctor before doing intense exercise, heavy lifting, or anything that makes you strain.
• Keep your blood pressure in a healthy range if you have high blood pressure.

Diet and exercise

A balanced diet with plenty of vegetables, fruit, whole grains, and lean protein can support general blood vessel health. Limit salt and highly processed foods. Regular activity, such as walking, is good for most people, but ask your specialist team first if you have a DAVF or have had treatment. Your team can tell you if you need to avoid certain activities.

Mental health and emotional wellbeing

It is normal to feel worried, anxious, or overwhelmed after a diagnosis like DAVF. Waiting for tests and deciding on treatment can be stressful. Talk to your specialist team about your concerns, and ask about counseling or psychological support. If you or someone you know is having thoughts of self-harm or suicide, call your local emergency number or a local crisis service right away.

Prevention

Most cases of DAVF cannot be prevented because the exact cause is often unknown. You can support your general blood vessel health by not smoking, managing high blood pressure, staying active, and eating a balanced diet.

Vaccines

There is no vaccine for DAVF.

Screening programmes

There is no routine screening test for DAVF. If you have had a blood clot in a vein around the brain, a head injury, or brain surgery, ask your doctor whether you need follow-up.

Complications

If left untreated

• Some low-risk DAVFs stay stable and do not cause serious problems.
• A higher-risk DAVF can bleed into the brain or cause a stroke.
• It can cause seizures, long-term weakness, or other neurological problems.
• It can cause vision loss or serious eye problems.
• In severe cases, it can strain the heart or cause heart failure.
• It can affect thinking, memory, or daily function over time.

Long-term outlook

Many people with DAVF do well with timely specialist care. Some need treatment, and some can be safely watched. The outlook depends on the type of DAVF, its location, and whether it is causing problems. Your specialist team can explain what is known about your case and what follow-up you need.

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