Brain dural AV fistulas are an under-recognized and under-treated cause of MCI and early dementia as the focus has traditionally been on acute presentations of these patients with neurological deficits, headaches rather than the cognitive impact. Patients are known to present with disorders such as Parkinsonism, MCI and early dementia which can resemble vascular dementia or fronto-temporal dementia. This adversely impacts the quality of life of patients and their family members. Similarly, spinal dural fistula can present with varying degrees of paraparesis to paraplegia, that eventually affect the quality of life of the individual. Both the diseases can be effectively treated by endovascular or uncommonly, surgical approaches.
The understanding of cognitive networks in the brain has been compounded by research into resting-state or 'task-free' blood oxygen level dependent activations in various regions using functional MRI. This has led to the understanding that certain regions of the brain are connected with others and may play a vital role in execution of specific neurological functions. At SCTIMST, specialists routinely rely heavily on MRI to understand the disease, and delineation of angiomorphology prior to subjecting the patient for detailed angiogram and subsequent management. The researcher team also study the impact of brain perfusion dysregulation on connectivity of brain regions concerned with consciousness, focused and sustained attention, visual-verbal memory encoding, executive control, orientation and other cognitive domains. Early diagnosis and timely neurointervention has been demonstrated to improve brain network connectivity among regions concerned with memory as well as processing speed and executive control. This improvement in connectivity positively correlates with neuropsychology test score performances and at a functional level to better quality of life for patients with this eminently treatable cognitive disorder. Neurointerventional radiologists perform complex endovascular procedures (transarterial or transvenous approaches) routinely for the effective treatment of dural arteriovenous fistula.