Abstract
(1) Background: Dural arteriovenous fistulas (DAVF) represent a rare acquired intracranial vascular malformation, with a variety of clinical signs and symptoms, which make their diagnosis difficult. Intracranial hemorrhage is one of the most serious clinical manifestations. In this paper the authors’ goal was to verify the accuracy and utility of contrast-enhanced brain CT angiography (CTA) for the identification and the characterization of dural arteriovenous fistulas (DAVFs) in patients who presented with brain hemorrhage compared to 3D digital subtraction angiography (3D DSA); (2) a retrospective study of 26 patients with DAVFs who presented with intracranial hemorrhage to our institution was performed. The information reviewed included clinical presentation, location and size of hemorrhage, brain CTA and 3D DSA findings; (3) results: 61% (16/26) of DAVFs were identified by CTA. The vast majority of patients were male (69%, 18/26) and the most common presenting symptom was sudden onset headache. All DAVFs had cortical venous drainage and about one-third were associated with a venous varix. The most common location was tentorial (73%, 19/26); (4) conclusions: CTA can represent a valid alternative diagnostic method to 3D DSA for the study of DAVF in the initial and preliminary diagnostic approach, especially in emergency situations. In fact, it represents a fast, inexpensive, non-invasive and above all, easily accessible and available diagnostic technique, unlike DSA or MRI, allowing to provide information necessary for the identification, classification and treatment planning of DAVFs.
Highlights
Generalized neurological symptoms may be due to venous hypertension or cerebrospinal fluid malabsorption, while other symptoms, such as cranial nerve palsy, often refer to arterial steal or mass effect events caused by an enlarged arterial supply [3,7,21]
The presence of Dural arteriovenous fistulas (DAVF) complicated by retrograde leptomeningeal drainage in either the cerebral, cerebellar cortical veins, or both, is a dangerous condition because it may cause intracranial hypertension and increase the risk of intracranial hemorrhage (ICH)
Since all intracranial DAVFs can be associated with leptomeningeal venous reflux, they can present with ICH
Summary
The dura mater of the brain [1,2,3] without a focal nidus, unlike many other cerebral arteriovenous malformations [1] These vascular malformations can be identified anywhere along the dura, but are often found in the region of the transverse, sigmoid and cavernous sinuses [2,4,5,6]. DAVF can present with a variety of clinical signs and symptoms in relation to the location, but especially in relation to the venous drainage pattern. The latter feature determines the risk of serious sequelae [7,8,9,10,11]. We verify the accuracy and the utility of contrastenhanced brain CT angiography (CTA) for the identification and the characterization of DAVFs in patients with brain hemorrhage as first diagnostic exam after non enhanced CT exam at the emergency room of our hospital in the last five years between 2017 and 2021
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