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.
- Fortschritte der Neurologie · Psychiatrie 12/2009; 77(12):699-707. · 0.76 Impact Factor
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ABSTRACT: To make prompt diagnosis of intracranial dural arteriovenous shunt (DAVS) with spinal venous drainage, classified as Cognard type V, is difficult. The authors investigated the angiographic and magnetic resonance imaging (MRI) characteristics of Cognard type V DAVS to determine the reason for difficulty in early diagnosis. The authors systematically reviewed 54 published and 3 new cases of Cognard type V DAVS. The pattern of venous drainage was classified on the basis of relative dominance of the anterior and posterior spinal veins using angiograms. T2-weighted sagittal MRIs were used to detect signal flow voids of enlarged spinal veins. Types of venous drainage were determined in 49 of the 57 cases. Twenty-eight and 8 cases showed a dominance of anterior and posterior spinal venous drainage, respectively. In 13 cases, venous drainage was equally distributed through the anterior and posterior spinal veins. Among 41 cases with an abnormally dilated anterior spinal vein, MR images were available for 25 cases. Signal flow voids of enlarged anterior spinal veins were detected in 9 (36.0%) cases, whereas dilatation of the posterior spinal veins was apparent in 9 of 16 cases (56.3%). Overall, MRI detected enlargement of either anterior or posterior spinal veins in 15 of 41 cases (36.6%). In Cognard type V DAVS, anterior venous drainage is dominant. Since the anterior spinal veins are located subpially, flow voids are less prominent on sagittal T2-weighted MRI. This may lead to difficulties in diagnosing. Evaluation using MR angiography may compensate for these limitations.Neurosurgery 07/2013; · 3.03 Impact Factor
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ABSTRACT: A cerebral dural arteriovenous fistula (DAVF) is an acquired abnormal arterial-to-venous connection within the leaves of the intracranial dura with a wide range of clinical presentations and natural history. The Cognard classification correlates venous drainage patterns with neurological course, identifying 5 DAVF types with increasing rates of symptomatic presentation. A spinal DAVF occurs when a radicular artery makes a direct anomalous shunt with a radicular vein within the dural leaflets of the nerve root sleeve. A cervical DAVF is a rare entity, as most spinal DAVFs present as thoracolumbar lesions with myelopathy. In this paper the authors present 2 patients presenting initially with brainstem dysfunction rather than myelopathy secondary to craniocervical DAVF. The literature is then reviewed for similar rare aggressive DAVFs at the craniocervical junction presenting with brainstem symptomatology.Neurosurgical FOCUS 05/2012; 32(5):E10. · 2.14 Impact Factor