Intracranial dural arteriovenous fistula with venous reflux to the brainstem and spinal cord mimicking brainstem infarction--case report.
ABSTRACT A 73-year-old man presented with a rare transverse sinus dural arteriovenous fistula (dAVF) with venous reflux to the brainstem and medulla manifesting as brainstem and spinal cord edema mimicking brainstem infarction. Complete occlusion of the fistula was achieved by transvenous embolization, resulting in angiographic cure of the fistula and progressive improvement of the symptoms. Intracranial dAVFs with perimedullary venous drainage, type V according to the Cognard classification, are rare lesions with distinctive clinical, radiological, and therapeutic aspects. This case demonstrates that the symptoms of dAVF with perimedullary venous reflux are variable, so dAVF should be considered in patients with clinical and radiological findings suggestive of congestion in the brainstem and spinal cord. Dysfunction of the medulla and spinal cord caused by venous hypertension is the most probable cause of the neurological symptoms in such cases. Interventional therapy can lead to angiographic cure and resolution of the symptoms.
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ABSTRACT: Brainstem venous congestion is a rare but serious complication of the CS-dAVF (cavernous sinus dural arteriovenous fistual). A 71-year-old woman presented with right abducens nerve palsy. Brain MRI showed a solitary lesion in the right upper pons. Cerebral angiogram revealed the right CS-dAVF with retrograde venous drainage into the cerebellar cortical veins and the anterior pontomesencephalic vein. The patient was treated with stereotactic radiosurgery, resulting in complete resolution of the pontine lesion and the neurologic symptom. A solitary brainstem lesion can be caused by CS-dAVF as a rare complication. Careful diagnosis and treatment are important to avoid permanent neurologic deficits.Surgical Neurology 06/2006; 65(5):516-8; discussion 519. DOI:10.1016/j.surneu.2005.06.044 · 1.67 Impact Factor
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ABSTRACT: We report a case of intracranial dural arteriovenous (DAVF) draining into the spinal medullary veins. A 49-year-old woman presented a rapidly progressive ascending myelopathy resulting in a C3-C4 tetraplegia associated with acute respiratory failure at the twelfth hour. MRI revealed swelling of the cervical spinal cord, hyperintensity on T2 and enhancement of enlarged veins on MR angiography. A conventional angiography showed the DAVF with venous drainage into the spinal vein extending to the conus medullaris. After embolization, neurological recovery occurred during the first week, allowing tracheal extubation on day 2. Clinical, radiological and therapeutic aspects of this uncommon pathology are presented.Annales Françaises d Anesthésie et de Réanimation 10/2005; 24(10):1297-1301. DOI:10.1016/j.annfar.2005.05.016 · 0.84 Impact Factor
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ABSTRACT: Dural arteriovenous fistulas presenting with ascending myelopathy are characterised by the presence of an abnormal retrograde drainage through spinal veins. The authors present a case of cranial dural arteriovenous fistula causing brainstem dysfunction secondary to venous hypertension, treated by surgical interruption of the pial venous drainage which resulted in complete clinical and radiological resolution of the brainstem lesion.Acta Neurochirurgica 02/2007; 149(9):965-7; discussion 967. DOI:10.1007/s00701-007-1250-x · 1.79 Impact Factor