Factor for Diagnosis Delay on Symptomatic Dural Arteriovenous Fistula in Central Nervous Systems

Objective: Symptomatic dural arteriovenous fistula（sDAVF） has various manifestations. As patients with sDAVF consult specialists on the basis of the symptoms they are experiencing, there is a possibility that diagnosis could be delayed if the specialists are not neurologists.
We investigated the medical history of sDAVF patients and the time interval from onset to hospitalization, MRI and diagnosis, in order to clarify the diagnostic delay in such patients.
Methods: We defined each stage from sDAVF onset to diagnosis as follows: day of onset （Sx）, day of first visit to doctor（ 1st Dr）, day of second visit to doctor（ 2nd Dr）, total number of doctors（ relay）, day of initial MRI study （1st MR）, and day of diagnosis （Dx）. We then calculated the time interval in days between each stage as:（ Sx-Dx）,（ Sx-1st Dr）,（ 1st Dr-1st MR）, and（ 1st MR-Dx）. We divided the 20 patients into two groups according to the period from onset to diagnosis: a “no delay” group of less than 70 days, and a “delay” group
of more than 71 days, and analyzed which specific time interval was mostly responsible for the delay in sDAVF diagnosis.
Results: There was significant differences between the two groups in time intervals（ 1stDr-1st MR）（ 5.5days vs 83 days, p = 0.0043） and in numbers of relay （2.5 vs 4, p = 0.0211）. Whereas no influence in time intervals of（ Sx-1st Dr）（ 6.5 days vs 30.5 days, p = 0.3288） and （1stMR-Dx）（ 2.5days vs 14 days, p = 0.206）. Conclusion: Undertaking an MRI study was most important factor for sDAVF diagnosis. Increased awareness of this disease might shorten the（ 1st Dr-MR） time interval and facilitate speedier and more accurate diagnosis.