Background Dural arteriovenous fistulas are intracranial vascular malformations, fed by dural arteries and draining venous sinuses or meningeal veins. Clinical course varies widely and ranges from benign with spontaneous remission to fatal, due to cerebral hemorrhage. In a 10-year single institution experience, clinical presentation of dural arteriovenous fistulas, and in particular headache and angiographic features, as well as long-term outcome were analyzed. Methods Data of 42 intracranial dural arteriovenous fistulas of 40 patients concerning demographic characteristics, medical history and risk factors, clinical presentation and headache features, location and neuroimaging findings, as well as treatment and outcome, were collected. Furthermore, we used the modified-Rankin Scale to assess the long-term outcome, by telephone contact with patients and/or their relatives. Results Patients aged between 25 and 89 years (mean age 55.8 ± 15.5). According to different clinical presentation and evolution, related to their unique drainage pattern into the cavernous sinus, we examined the carotid-cavernous fistulas separately from other dural arteriovenous fistulas. Interestingly, we found that the migraine-like headache was the major onset symptom of dural arteriovenous fistulas different from carotid-cavernous fistulas ( p = 0.036). On the other hand, non-migraine-like headache was a typical characteristic of carotid-cavernous fistulas ( p = 0.003). Moreover, ocular symptoms were more frequently observed in carotid-cavernous fistulas (92.9% p < 0.001). Seventy percent of patients did not report any impact on quality of life (mRS 0 or 1) at follow-up. Conclusions These findings suggest a link between the site of lesion and clinical features of the headache, a symptom that usually leads to hospitalization. In particular, ocular symptoms accompanying non-migraine-like headache should be promptly recognized and raise the suspicion of a carotid-cavernous fistula, while migraine-like headache may suggests other dural arteriovenous fistulas. This study provides new significant insights on headache and its characteristics as a presentation symptom in dural arteriovenous fistulas.

中文翻译：

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硬脑膜动静脉瘘和头痛特征：一项观察性研究

背景硬脑膜动静脉瘘是颅内血管畸形，由硬脑膜动脉和引流静脉窦或脑膜静脉供血。临床病程差异很大，范围从良性自发缓解到致命性脑出血。在 10 年的单一机构经验中，分析了硬脑膜动静脉瘘的临床表现，特别是头痛和血管造影特征，以及长期结果。方法收集40例42例颅内硬脑膜动静脉瘘的人口学特征、病史和危险因素、临床表现和头痛特征、位置和神经影像学发现以及治疗和结果的数据。此外，我们使用改良的 Rankin 量表来评估长期结果，通过电话联系患者和/或其亲属。结果 患者年龄在 25 至 89 岁之间（平均年龄 55.8 ± 15.5）。根据不同的临床表现和演变，与其进入海绵窦的独特引流模式有关，我们将颈动脉海绵窦瘘与其他硬脑膜动静脉瘘分开检查。有趣的是，我们发现偏头痛样头痛是硬脑膜动静脉瘘不同于颈动脉海绵窦瘘的主要发病症状（p = 0.036）。另一方面，非偏头痛样头痛是颈动脉海绵窦瘘的典型特征（p = 0.003）。此外，在颈动脉海绵窦瘘中更常观察到眼部症状（92.9% p < 0.001）。70% 的患者在随访时未报告对生活质量（mRS 0 或 1）有任何影响。结论 这些发现表明病变部位与头痛的临床特征之间存在联系，这种症状通常会导致住院治疗。特别是，应及时识别伴随非偏头痛样头痛的眼部症状，并怀疑颈动脉海绵窦瘘，而偏头痛样头痛可能提示其他硬脑膜动静脉瘘。这项研究为头痛及其作为硬脑膜动静脉瘘的表现症状的特征提供了新的重要见解。而偏头痛样头痛可能提示其他硬脑膜动静脉瘘。这项研究为头痛及其作为硬脑膜动静脉瘘的表现症状的特征提供了新的重要见解。而偏头痛样头痛可能提示其他硬脑膜动静脉瘘。这项研究为头痛及其作为硬脑膜动静脉瘘的表现症状的特征提供了新的重要见解。