ISSN: 1899-0967
Polish Journal of Radiology
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vol. 84
Interventional radiology
Letter to the Editor

Intracranial haemorrhage in dural arteriovenous fistula

Tushar Garg

Seth GS Medical College & KEM Hospital, Mumbai, India
© Pol J Radiol 2019; 84: e402
Online publish date: 2019/10/11
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I read the article by Brzozowski et al. about the percentage of intracranial haemorrhage in type I dural arteriovenous fistula with great interest [1]. In the paper, the authors demonstrated that 50% of patients with dural arteriovenous fistula presented with intracranial haemorrhage. However, the results of the paper were not concordant with the already published data in some larger studies (n = 236-1075), which have demonstrated a risk of intracranial haemorrhage between 12% and 23.7% [2-5] (Table 1). In the paper published by Li et al., only two cases out of the reported 91 with Borden type I (Cognard type I and type IIa) dural arteriovenous fistulas presented with an intracranial haemorrhage, as compared to 28.6% in the authors’ paper. The sample size of the study and the inclusion of only those patients who were managed with embolisation probably contributed to this discrepancy.

Table 1

Review of literature on the presence of intracranial haemorrhage in patients with dural arteriovenous fistula

PaperNumber of patients% of patients presenting with haemorrhage% of patients presenting with haemorrhage in Cognard type 1 dural arteriovenous fistula
Li et al.23623.7% (n = 56)3.6% (n = 2)
Hiramatsu et al.107512.0% (n = 129)
Piippo et al.26113.0% (n = 34)
Singh et al.40218.0% (n = 72)


The author declares no conflict of interests.



Brzozowski K, Narloch J, Piasecki P, et al. , authors. Are type I dural arteriovenous fistulas safe? Single-centre experience of endovascular treatment of dural arteriovenous fistulas. Pol J Radiol. 2019. 84:p. 179–184


Li C, Wang Y, Li Y, et al. , authors. Clinical and angioarchitectural risk factors associated with intracranial hemorrhage in dural arteriovenous fistulas: a single-center retrospective study. PLoS One. 2015. 10:p. e0131235


Singh V, Smith WS, Lawton MT, et al. , authors. Risk factors for hemorrhagic presentation in patients with dural arteriovenous fistulae. Neurosurgery. 2008. 62:p. 628–635


Hiramatsu M, Sugiu K, Hishikawa T, et al. , authors. Epidemiology of dural arteriovenous fistula in Japan: Analysis of Japanese Registry of Neuroendovascular Therapy (JR-NET2). Neurol Med Chir (Tokyo). 2014. 54:p. 63–71


Piippo A, Niemelä M, van Popta J, et al. , authors. Characteristics and long-term outcome of 251 patients with dural arteriovenous fistulas in a defined population. J Neurosurg. 2013. 118:p. 923–934

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