New daily persistent headache — rare primary or secondary phenomena caused by carotid-cavernous fistula? A case report

AbstractCarotid cavernous fistulas (CCF) are dural arteriovenous fistulas which include pathological communications between the arterial system and the venous cavernous sinus situated at the wall of the cavernous sinus. It can be demonstrated by wide range clinical presentations. The presented case shows a very modest clinical presentation of CCF which was present over a few months only as new daily persistent headache without initial positive findings on performed computer tomography of the head, but rapidly worsened over a period of few days.

Download Full-text

Dural arteriovenous fistulas presenting with brainstem dysfunction: diagnosis and surgical treatment

Neurosurgical FOCUS ◽

10.3171/2012.2.focus1217 ◽

2012 ◽

Vol 32 (5) ◽

pp. E10 ◽

Cited By ~ 14

Author(s):

Charles Kulwin ◽

Bradley N. Bohnstedt ◽

John A. Scott ◽

Aaron Cohen-Gadol

Keyword(s):

Dural Arteriovenous Fistula ◽

Venous Drainage ◽

Craniocervical Junction ◽

Rare Entity ◽

Arteriovenous Fistulas ◽

Drainage Patterns ◽

Clinical Presentations ◽

Wide Range ◽

Brainstem Dysfunction ◽

Dural Arteriovenous Fistulas

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.

Download Full-text

Beware of the Brain Stem:Craniocervical Dural Arteriovenous Fistulas. Case Series and Literature Review

Neurographics ◽

10.3174/ng.1800064 ◽

2019 ◽

Vol 9 (6) ◽

pp. 349-357

Author(s):

M.A. McDonald ◽

S.E. Olson ◽

P. Abraham ◽

J. Handwerker

Keyword(s):

Literature Review ◽

Mr Imaging ◽

Case Series ◽

Imaging Findings ◽

Arteriovenous Fistulas ◽

Timely Diagnosis ◽

Clinical Presentations ◽

Wide Range ◽

Dural Arteriovenous Fistulas ◽

The Brain

Craniocervical dural arteriovenous fistulas are rare but clinically important entities that are potentially treatable but often misdiagnosed given their wide range of clinical presentations and often nonspecific findings on CT and MR imaging. Although DSA remains the criterion standard for diagnosis, the present case series highlights imaging findings of craniocervical dural arteriovenous fistulas and potential mimics to aid the practicing radiologist in a timely diagnosis.

Download Full-text

Carotid Cavernous Fistulas and Dural Arteriovenous Fistulas of the Cavernous Sinus: Validation of a New Classification According to Venous Drainage

World Neurosurgery ◽

10.1016/j.wneu.2019.04.220 ◽

2019 ◽

Vol 128 ◽

pp. e621-e631 ◽

Cited By ~ 1

Author(s):

Giuseppe Leone ◽

Leonardo Renieri ◽

Alejandro Enriquez-Marulanda ◽

Adam A. Dmytriw ◽

Sergio Nappini ◽

...

Keyword(s):

Cavernous Sinus ◽

Venous Drainage ◽

New Classification ◽

Arteriovenous Fistulas ◽

Dural Arteriovenous Fistulas ◽

Carotid Cavernous Fistulas

Download Full-text

Angio-Architectural Features of High-Grade Intracranial Dural Arteriovenous Fistulas: Correlation With Aggressive Clinical Presentation and Hemorrhagic Risk

Neurosurgery ◽

10.1093/neuros/nyw175 ◽

2017 ◽

Vol 81 (2) ◽

pp. 315-330 ◽

Cited By ~ 16

Author(s):

Giuseppe Maria Della Pepa ◽

Paolo Parente ◽

Francesco D’Argento ◽

Alessandro Pedicelli ◽

Carmelo Lucio Sturiale ◽

...

Keyword(s):

Clinical Presentation ◽

Venous Drainage ◽

Clinical History ◽

Venous Hypertension ◽

High Grade ◽

Arteriovenous Fistulas ◽

Clinical Risk ◽

Architectural Features ◽

Wide Range ◽

Dural Arteriovenous Fistulas

Abstract BACKGROUND: High-grade dural arteriovenous fistulas (dAVFs) can present shunts with very different angio-architectural characteristics. Specific hemodynamic factors may affect clinical history and determine very different clinical courses. OBJECTIVES: To evaluate the relationship between some venous angio-architectural features in high-grade dAVFs and clinical presentation. Specific indicators of moderate or severe venous hypertension were analyzed, such as altered configurations of the dural sinuses (by a single or a dual thrombosis), or overload of cortical vessels (restrictions of outflow, pseudophlebitic cortical vessels, and venous aneurysms). METHODS: The institutional series was retrospectively reviewed (49 cases), and the pattern of venous drainage was analyzed in relationship with clinical presentation (benign/aggressive/hemorrhage). RESULTS: Thirty-five of 49 cases displayed cortical reflux (high-grade dAVFs). This subgroup displayed a benign presentation in 31.42% of cases, an aggressive in 31.42%, and hemorrhage in 37.14%. CONCLUSIONS: Our data confirm that within high-grade dAVFs, 2 distinct subpopulations exist according to severity of clinical presentation. Some indicators we examined showed correlation with aggressive nonhemorrhagic manifestations (outflow restriction and pseudophlebitic cortical vessels), while other showed a correlation with hemorrhage (dual thrombosis and venous aneurysms). Current classifications appear insufficient to identify a wide range of conditions that ultimately determine the organization of the cortical venous drainage. Intermediate degrees of venous congestion correlate better with the clinical risk than the simple definition of cortical reflux. The angiographic aspects of venous drainage presented in this study may prove useful to assess dAVF hemodynamic characteristics and identify conditions at higher clinical risk.

Download Full-text

Gamma Knife surgery for low-flow cavernous sinus dural arteriovenous fistulas

Journal of Neurosurgery ◽

10.3171/2010.8.gks10977 ◽

2010 ◽

Vol 113 (Special_Supplement) ◽

pp. 21-27 ◽

Cited By ~ 5

Author(s):

Hyun Ho Jung ◽

Jong Hee Chang ◽

Kum Whang ◽

Jin Soo Pyen ◽

Jin Woo Chang ◽

...

Keyword(s):

Gamma Knife ◽

Cavernous Sinus ◽

Transarterial Embolization ◽

Gamma Knife Surgery ◽

Low Flow ◽

Close Monitoring ◽

Arteriovenous Fistulas ◽

Ocular Symptoms ◽

Dural Arteriovenous Fistulas

Object The purpose of this study was to assess the efficacy of Gamma Knife surgery (GKS) for treating cavernous sinus dural arteriovenous fistulas (CSDAVFs). Methods Of the 4123 GKSs performed between May 1992 and March 2009, 890 procedures were undertaken to treat vascular lesions. In 24 cases, the vascular lesion that was treated was a dural arteriovenous fistula, and in 6 of these cases, the lesion involved the cavernous sinus. One of these 6 cases was lost to follow-up, leaving the other 5 cases (4 women and 1 man) to comprise the subjects of this study. All 5 patients had more than 1 ocular symptom, such as ptosis, chemosis, proptosis, and extraocular movement palsy. In all patients, CSDAVF was confirmed by conventional angiography. Three patients were treated by GKS alone and 2 patients were treated by GKS combined with transarterial embolization. The median follow-up period after GKS in these 5 cases was 30 months (range 9–59 months). Results All patients experienced clinical improvement, and their improvement in ocular symptoms was noticed at a mean of 17.6 weeks after GKS (range 4–24 weeks). Two patients received embolization prior to GKS but did not display improvement in ocular symptoms. An average of 20 weeks (range 12–24 weeks) was needed for complete improvement in clinical symptoms. There were no treatment-related complications during the follow-up period. Conclusions Gamma Knife surgery should be considered as a primary, combined, or additional treatment option for CSDAVF in selected cases, such as when the lesion is a low-flow shunt without cortical venous drainage. For those selected cases, GKS alone may suffice as the primary treatment method when combined with close monitoring of ocular symptoms and intraocular pressure.

Download Full-text

Compression neuropathies of the forearm: anatomy, clinical features and management

British Journal of Hospital Medicine ◽

10.12968/hmed.2021.0187 ◽

2021 ◽

pp. 1-10

Author(s):

Alexander Scarborough ◽

Robert J MacFarlane ◽

Michail Klontzas ◽

Rui Zhou ◽

Mohammad Waseem

Keyword(s):

Peripheral Nerve ◽

Brachial Plexus ◽

Upper Limb ◽

Peripheral Nerves ◽

Clinical Presentation ◽

Permanent Damage ◽

Peripheral Nerve Lesions ◽

Clinical Presentations ◽

Wide Range ◽

Prompt Diagnosis

The upper limb consists of four major parts: a girdle formed by the clavicle and scapula, the arm, the forearm and the hand. Peripheral nerve lesions of the upper limb are divided into lesions of the brachial plexus or the nerves arising from it. Lesions of the nerves arising from the brachial plexus are further divided into upper (proximal) or lower (distal) lesions based on their location. Peripheral nerves in the forearm can be compressed in various locations and by a wide range of pathologies. A thorough understanding of the anatomy and clinical presentations of these compression neuropathies can lead to prompt diagnosis and management, preventing possible permanent damage. This article discusses the aetiology, anatomy, clinical presentation and surgical management of compressive neuropathies of the upper limb.

Download Full-text

Dural Arteriovenous Fistulas in the Parasellar Region Other Than the Cavernous Sinus

Journal of Neuroendovascular Therapy ◽

10.5797/jnet.ra.2020-0042 ◽

2020 ◽

Vol 14 (12) ◽

pp. 593-604

Author(s):

Masafumi Hiramatsu ◽

Kenji Sugiu ◽

Jun Haruma ◽

Tomohito Hishikawa ◽

Yu Takahashi ◽

...

Keyword(s):

Cavernous Sinus ◽

Arteriovenous Fistulas ◽

Parasellar Region ◽

Dural Arteriovenous Fistulas

Download Full-text

Pitfalls in Endovascular Treatment of Dural Arteriovenous Fistulas Involving the Cavernous Sinus

Interventional Neuroradiology ◽

10.1177/15910199970030s217 ◽

1997 ◽

Vol 3 (2_suppl) ◽

pp. 88-92

Author(s):

N. Kuwayama ◽

S. Endo ◽

M. Kubo ◽

T. Akai ◽

A. Takaku

Keyword(s):

Endovascular Treatment ◽

Cavernous Sinus ◽

Nerve Palsy ◽

Transarterial Embolization ◽

Abducens Nerve ◽

Abducens Nerve Palsy ◽

Arteriovenous Fistulas ◽

Type D ◽

Dural Arteriovenous Fistulas ◽

The Right

Angiographic changes of the sylvian veins, superior ophthalmic vein (SOV), and superior petrosal sinus (SPS) before and after endovascular treatment were determined for 18 patients with dural arteriovenous fistulas (AVFs) involving the cavernous sinus, and pitfalls of endovascular treatment, especially regarding venous drainage routes, for 3 of the patients were reported. Case 1: 57-year-old woman who presented with right abducens nerve palsy had a Barrow type D fistula in the right cavernous sinus draining into the bilateral inferior petrosal sinuses (IPS). One of the ipsilateral sylvian veins that had drained antegradely before treatment was occluded, and a small lacunar infarction in the corona radiata developed after transvenous embolization (TVE) of the right cavernous sinus. Case 2: 72-year-old woman who presented with symptoms of right ocular hypertension had a type D fistula in the right cavernous sinus draining into only the ipsilateral SOV. Conjunctival hyperemia persisted and was aggravated after angioanatomical obliteration of the fistula by transarterial embolization. Case 3: 55-year-old man who presented with left abducens nerve palsy had a type D fistula in the left cavernous sinus draining into the ipsilateral IPS and sylvian vein. The dural AVF was obliterated once with TVE, but recurred 1 week later with retrograde drainage into the ipsilateral SPS and mesencephalic veins. A second TVE resulted in complete obliteration of the fistula. In conclusion, detailed analysis of drainage routes is necessary for planning of treatment of patients with dural AVF, and prompt treatment is needed when redistribution of drainage routes develops during or after TVE.

Download Full-text