We report a rare case of progressive myelopathy caused by intracranial dural arteriovenous fistula with venous drainage into the spinal perimedullary veins. A 45-yr-old man developed urinary and fecal incontinence and muscle weakness in the lower limbs. Magnetic resonance imaging revealed brainstem edema and dilated veins of the brainstem and spinal cord. Cerebral angiography showed a dural arteriovenous fistula fed by the neuromeningeal branch of the left ascending pharyngeal artery. Occlusion of the fistula could be achieved by embolization after a diagnostic and subsequent therapeutic delay. There was no improvement in clinical condition. For the neurologic outcome of these patients it is important that fistula must be treated before ischemic and gliotic changes become irreversible.
Spinal Cord Diseases/*etiology ; Middle Aged ; Male ; Magnetic Resonance Imaging ; Humans ; Dura Mater/*blood supply ; Arteriovenous Fistula/*complications/diagnosis

BACKGROUNDChronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) are two chronic diseases that affect negatively the functional condition and quality of life of patients. We assessed the effect of symptoms and clinical variables on the functional capacity and quality of life in COPD and CHF patients.

METHODSThe study included 42 COPD and 39 CHF patients. In both patient groups, dyspnea was assessed using Borg scale; functional capacity by shuttle-walk and cardiopulmonary exercise test and quality of life by short form-36 (SF36).

RESULTSNo statistically significant difference was found in neither of the two disease groups regarding the dyspnea score, shuttle-walk test and the majority of subgroup scores of SF36 (P > 0.05). A statistically significant difference was observed in peak VO2 in favor of COPD group (P < 0.05). No significant relationship was established between dyspnea score and forced expiratory volume in one second (FEV1) in COPD patients, and left ventricular ejection fraction (LVEF) in CHF patients (P > 0.05). A significant negative correlation was observed between dyspnea score and functional capacity tests in both disease groups (P < 0.05). On the other hand, no relationship was found between LVEF and FEV1 and quality of life and functional capacity (P > 0.05).

CONCLUSIONSIt was revealed that symptoms have an impact on functional capacity and quality of life in both disease groups, however, objective indicators of disease severity do not show a similar relationship. Therefore, in addition to the objective data related to the disease, we recommend that symptoms should also be taken into consideration to assess cardiopulmonary rehabilitation program and during following-up.

Adult ; Aged ; Dyspnea ; psychology ; Female ; Forced Expiratory Volume ; Heart Failure ; physiopathology ; psychology ; Humans ; Male ; Middle Aged ; Pulmonary Disease, Chronic Obstructive ; physiopathology ; psychology ; Quality of Life ; Ventricular Function, Left