scholarly journals Acute Brainstem Dysfunction Caused by Cavernous Sinus Dural Arteriovenous Fistula

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Yuwa Oka ◽  
Kenichi Komatsu ◽  
Soichiro Abe ◽  
Naoya Yoshimoto ◽  
Junya Taki ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Arteriovenous Fistula ◽  
Digital Subtraction Angiography ◽  
Cavernous Sinus ◽  
Dural Arteriovenous Fistula ◽  
Inflammatory Diseases ◽  
Digital Subtraction ◽  
Arteriovenous Fistulas ◽  
Ocular Symptoms ◽  
Brainstem Dysfunction

Symptoms of cavernous sinus dural arteriovenous fistula depend on the drainage patterns and are very diverse. Among these, brainstem dysfunction is a rare but serious complication. Here, we describe a case with isolated and rapidly progressive brainstem dysfunction due to cavernous sinus dural arteriovenous fistula. An 80-year-old woman presented with a 2-day history of progressive gait disturbance. Neurological examination revealed mild confusion, dysarthria, and left hemiparesis. Magnetic resonance imaging (MRI) revealed pontine swelling without evidence of infarction. Magnetic resonance angiography suggested a faint abnormality near the cavernous sinus. Dural arteriovenous fistula was suspected, and digital subtraction angiography was planned for the next day. Her condition had progressed to coma by the next morning. Pontine swelling worsened, and hyperintensity appeared on diffusion-weighted imaging. Digital subtraction angiography revealed a right-sided cavernous sinus dural arteriovenous fistula with venous reflux into the posterior fossa. Orbital or ocular symptoms had preceded brainstem symptoms in all nine previously reported cases, but brainstem symptoms were the only presentation in our case, making the diagnosis difficult. Some dural arteriovenous fistulas mimic inflammatory diseases when the clinical course is acute. Prompt diagnosis using enhanced computed tomography or MRI and emergent treatment are needed to avoid permanent sequelae.

scholarly journals Dilated MMA sign in cDAVF and other arterial feeders on 3D TOF MRA

2021 ◽  
pp. 197140092110415
Author(s):  
Sin Y Foo ◽  
Saravana K Swaminathan ◽  
Timo Krings
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Confidence Interval ◽  
Arteriovenous Fistula ◽  
Digital Subtraction Angiography ◽  
Dural Arteriovenous Fistula ◽  
Middle Meningeal Artery ◽  
Digital Subtraction ◽  
Meningeal Artery ◽  
Meningohypophyseal Trunk

Background Among the varied causes of pulsatile tinnitus, the condition that can cause severe mortality and morbidity is a cranial dural arteriovenous fistula (cDAVF). This study aimed to assess the diagnostic accuracy of the dilated middle meningeal artery on three-dimensional time-of-flight magnetic resonance angiography in cranial dural arteriovenous fistula and to identify other feeders that can aid in the detection of these lesions. Method Magnetic resonance angiography and digital subtraction angiography data of all patients with cranial dural arteriovenous fistula treated in a single tertiary referral center between 2007–2020 were included. The middle meningeal artery and other feeders recorded from digital subtraction angiography were assessed on magnetic resonance angiography. Results The overall agreement between readers in identifying the dilated middle meningeal artery was substantial (κ = 0.878, 95% confidence interval: 0.775–0.982). The dilated middle meningeal artery indicated the presence of a cranial dural arteriovenous fistula with a sensitivity of 79.49% (95% confidence interval: 66.81–92.16), specificity of 100% (95% confidence interval: 100.00–100.00), and negative predictive value of 94.56% (95% confidence interval: 90.89–98.02). An area under the curve of 0.8341 was observed for the ipsilateral middle meningeal artery, with a sensitivity of 92.2% and a specificity of 75.0% at a cut-off of 0.30 mm for identifying a cranial dural arteriovenous fistula. Of 73 other feeders, the occipital, meningohypophyseal trunk, ascending pharyngeal, and posterior meningeal arteries contributed to a large proportion visualized on magnetic resonance angiography (83.6% (41/49)). Conclusion The dilated middle meningeal artery sign is useful for identifying a cranial dural arteriovenous fistula. Dilatation of the occipital and ascending pharyngeal arteries and meningohypophyseal trunk should be assessed to facilitate the detection of a cranial dural arteriovenous fistula, particularly in the transverse-sigmoid and petrous regions.

A Septuagenarian With Progressive Lower Extremity Weakness and Pain

2021 ◽  
pp. 235-237
Author(s):  
Nicholas L. Zalewski
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Lower Extremity ◽  
Arteriovenous Fistula ◽  
Digital Subtraction Angiography ◽  
Dural Arteriovenous Fistula ◽  
Digital Subtraction ◽  
Resonance Imaging ◽  
Spinal Dural Arteriovenous Fistula ◽  
Lower Extremity Weakness

A 75-year-old man was referred for evaluation of treatment-resistant transverse myelitis. His medical history included hypertension, coronary artery disease, benign prostatic hyperplasia, and chronic kidney disease. Eight years earlier, the patient noted development of radiating pain down the left lower extremity during long drives, lower extremity weakness and pain, on the left greater than right. He received epidural lumbar corticosteroid injections. Nine months before the current evaluation, his symptoms became refractory, and he underwent surgical decompression with laminectomy at L3-L5. This provided substantial relief for the lower extremity pain. Review of outside magnetic resonance imaging indicated multilevel lumbar stenosis before his surgery and possible, faint, T2-hyperintense cord signal extending into the conus. At the time his symptoms worsened, magnetic resonance imaging of the thoracic spine showed longitudinally extensive T2 hyperintensity extending from the thoracic cord into the conus without contrast enhancement. Evaluation in our department included cerebrospinal fluid analysis, which showed an increased protein concentration of 92 mg/dL, 1 total nucleated cell/µL, normal immunoglobulin G index, and no supernumerary oligoclonal bands. Magnetic resonance angiography of the spinal canal showed mild prominence of vascularity at T10-T12 but no clear spinal dural arteriovenous fistula. However, given the strong suspicion for spinal dural arteriovenous fistula in an older man with progressive myelopathy worsening with corticosteroids, longitudinally extensive lesion extending into the conus, and no evidence of inflammation, spinal digital subtraction angiography was performed. The spinal digital subtraction angiography confirmed the diagnosis of left spinal dural arteriovenous fistula at T11. A T11-12 laminectomy and ligation of the spinal dural arteriovenous fistula was successfully performed without complication. The patient followed up with his local providers for rehabilitation. Spinal dural arteriovenous fistula is the most common spinal arteriovenous malformation, arising from an acquired abnormal connection between a radicular artery and radiculomedullary vein. Progressive congestion and cord edema lead to neurologic deficits over time. Cases are commonly seen in older men with a history of back surgery or trauma. A delay in diagnosis of 1 to 3 years is common.

scholarly journals Serious myelopathy due to magnetic resonance imaging-occult arteriovenous fistula: Case report of petrous ridge dural arteriovenous fistula

2015 ◽  
Vol 21 (5) ◽  
pp. 609-612
Author(s):  
Hyun Jeong Kim ◽  
In Sup Choi
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Slow Flow ◽  
Digital Subtraction ◽  
Resonance Imaging ◽  
Progressive Myelopathy ◽  
Vascular Origin ◽  
Magnetic Resonance Imaging Mri

Background and purpose We present a case of magnetic resonance imaging (MRI)-occult intracranial dural arteriovenous fistula (DAVF) with serious cervical myelopathy and review the pathophysiological background. Summary of case A 61-year-old man had suffered from progressive neurological deterioration. He had demonstrated swollen spinal cord with diffuse enhancement and no dilated vascularity on MRI. Finally, digital subtraction angiography revealed DAVF at the petrous ridge and it was successfully treated by embolization. Conclusion A slow flow DAVF is not readily recognizable on MRI. Whenever a patient presents with unexplainable progressive myelopathy, a possibility of vascular origin has to be considered.

scholarly journals Paraplegia after contrast media application: a transient or devastating rare complication? Case report

2016 ◽  
Vol 24 (5) ◽  
pp. 806-809 ◽  
Author(s):  
Dorothee Mielke ◽  
Kai Kallenberg ◽  
Marius Hartmann ◽  
Veit Rohde
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Contrast Media ◽  
Arteriovenous Fistula ◽  
Digital Subtraction Angiography ◽  
Dural Arteriovenous Fistula ◽  
Rare Complication ◽  
Digital Subtraction ◽  
Spinal Dural Arteriovenous Fistula ◽  
The Individual

The authors report the case of a 76-year-old man with a spinal dural arteriovenous fistula. The patient suffered from sudden repeated reversible paraplegia after spinal digital subtraction angiography as well as CT angiography. Neurotoxicity of contrast media (CM) is the most probable cause for this repeated short-lasting paraplegia. Intolerance to toxicity of CM to the vulnerable spinal cord is rare, and probably depends on the individual patient. This phenomenon is transient and can occur after both intraarterial and intravenous CM application.

scholarly journals A case of recurrent cavernous sinus dural arteriovenous fistula arising after superselective shunt occlusion and detected by venous arterial spin labeling

2021 ◽  
Vol 12 ◽  
pp. 594
Author(s):  
Hiromu Sunada ◽  
Ryosuke Maeoka ◽  
Ichiro Nakagawa ◽  
Hiroyuki Nakase ◽  
Hideyuki Ohnishi
Keyword(s):  
Arteriovenous Fistula ◽  
Cavernous Sinus ◽  
Arterial Spin Labeling ◽  
Dural Arteriovenous Fistula ◽  
Spin Labeling ◽  
Digital Subtraction ◽  
Resonance Imaging ◽  
Shunt Occlusion ◽  
Paradoxical Worsening ◽  
The Right

Background: Superselective shunt occlusion (SSSO) for cavernous sinus dural arteriovenous fistula (CSDAVF) avoids the risk of cranial nerve palsy, unlike entire sinus packing, but requires paying attention to recurrence. Distinguishing between true and paradoxical worsening of postoperative ophthalmic symptoms using a less-invasive modality is often difficult. Here, we report a case of true worsening of neuro-ophthalmic symptom by recurrent CSDAVF detected by venous-arterial spin labeling (ASL) on magnetic resonance imaging. Case Description: A 55-year-old woman with neither contributory medical history nor previous head trauma presented with neuro-ophthalmic symptoms and pulsatile tinnitus. Digital subtraction angiography (DSA) revealed CSDAVF with multiple shunted pouches. She underwent successful transvenous SSSO, but neuroophthalmic symptom worsened after SSSO and venous-ASL revealed increased signal intensity in the right superior orbital vein (SOV). DSA confirmed recurrent CSDAVF and additional transvenous embolization was performed. Neuro-ophthalmic symptoms and venous-ASL hyperintensity on SOV improved postoperatively. Conclusion: Venous-ASL is noninvasive and seems useful for detecting true worsening of neuro-ophthalmic symptoms of recurrent CSDAVF.

scholarly journals Embolization of a Cavernous Sinus Dural Arteriovenous Fistula with Onyx via Direct Puncture of the Cavernous Sinus through the Superior Orbital Fissure

2009 ◽  
Vol 15 (2) ◽  
pp. 179-184 ◽  
Author(s):  
N. Amiridze ◽  
G. Zoarski ◽  
R. Darwish ◽  
A. Obuchowski ◽  
N. Soloveychic
Keyword(s):  
Arteriovenous Fistula ◽  
Cavernous Sinus ◽  
Dural Arteriovenous Fistula ◽  
Interventional Therapy ◽  
Superior Orbital Fissure ◽  
Direct Puncture ◽  
Ethylene Vinyl Alcohol ◽  
Trigeminocardiac Reflex ◽  
Ocular Symptoms ◽  
Transvenous Approach

Treatment of cavernous sinus dural arteriovenous fistula (CSDAVF) may be challenging. We describe a patient who had presented with progressive ocular symptoms due to CSDAVF requiring urgent interventional therapy. Initial attempts to embolize the fistula utilizing a transvenous approach through the inferior petrosal sinus failed because of difficult anatomy. Successful occlusion of the fistula was subsequently achieved with injection of ethylene vinyl alcohol copolymer, Onyx (EV3 Neurovascular, Irvine, CA, USA), via direct percutaneous puncture of the cavernous sinus through the superior orbital fissure. A brief period of asystole during the initial injection of Onyx may be the result of the trigeminocardiac reflex.

Whole-brain CT digital subtraction angiography of cerebral dural arteriovenous fistula using 320-detector row CT

2013 ◽  
Vol 55 (7) ◽  
pp. 837-843 ◽  
Author(s):  
Hirokazu Fujiwara ◽  
Suketaka Momoshima ◽  
Takenori Akiyama ◽  
Sachio Kuribayashi
Keyword(s):  
Arteriovenous Fistula ◽  
Digital Subtraction Angiography ◽  
Dural Arteriovenous Fistula ◽  
Digital Subtraction ◽  
Whole Brain ◽  
Brain Ct
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