Intracranial Dural Arteriovenous Fistula With Venous Reflux to the Brainstem and Spinal Cord Mimicking Brainstem Infarction-Case Report-

Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Miyagi, Japan.
Neurologia medico-chirurgica (Impact Factor: 0.72). 02/2004; 44(1):24-8. DOI: 10.2176/nmc.44.24
Source: PubMed


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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    • "About 2% of DAVF occur around the cervical spine, and in most cases they take form of myelopathy.5 It is very rare that lesions are located on the brain stem and upper cervical spinal cord, and there have been reports that such case accompany the symptoms of progressive myelopathy.6 It has been considered that spinal DAVF drained upward or inside the cranium are often related to SAH,7 and venous hypertension is thought to cause it although the exact mechanism has not been confirmed to date.8 "
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    ABSTRACT: A 53-year-old man abruptly developed headache and unconsciousness. Brain computed tomography (CT) and CT angiography showed subarachnoid hemorrhage, intraventricular hemorrhage, and multiple tortuous vascular structures on the brain stem and upper cervical spinal cord. Four-vessel angiography displayed intradural ventral arteriovenous fistula, supplied by the left vertebral and occipital arteries. Drainage was via both sigmoid sinus and cervical venous plexus. He had been treated with transarterial coil embolization of the left vertebral artery. Subsequently, he suffered from left hemiplegia and cognitive problem. Brain magnetic resonance (MR) and MR angiography performed 4 weeks later revealed multiple infarctions on the left cerebellum, left upper cervical spinal cord, and both medial thalamus, as well as occlusion of the left vertebral artery with reduction in varix size. After rehabilitative management, his muscle strength and cognitive function improved. We report a very rare case of dural arteriovenous fistula on the brain stem and upper cervical spinal cord.
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    • "To the best of our knowledge, a total of 6 such cases have been reported since 1997 [2] [6] [7]. Clinical symptoms of dAVF depend on location of the shunt and patterns of the venous drainage [1] [5]. On a review of the 6 cases, patients typically present with combinations of the classic symptoms such as chemosis, exophthalmos, ocular pain, headache, and diplopia. "
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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.
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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.
    No preview · Article · Oct 2005 · Annales Françaises d Anesthésie et de Réanimation
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