Arteriovenous Fistula Presenting Research Articles

Dural arteriovenous fistula presenting with cerebellar signs and obstructive hydrocephalus

Dural arteriovenous fistula presenting with cerebellar signs and obstructive hydrocephalus

Superior Mesenteric Arteriovenous Fistula Presenting as Portal Hypertension.

Superior Mesenteric Arteriovenous Fistula Presenting as Portal Hypertension.

Diagnosis and Minimally-Invasive Treatment of Posterior Fossa Dural Arteriovenous Fistula Presenting Clinically as A Carotid-Cavernous Fistula

A posterior fossa dural arteriovenous fistula presenting clinically as a carotid-cavernous fistula is a very rare and relatively unknown situation. They present with several clinical symptoms due to abnormal or excessive blood flowing into the cavernous sinuses. Although abnormal shunts between two vascular domains near each other may be expected (as in carotid-cavernous fistulas), an abnormal shunt from a distant artery to a cavernous venous sinus would be something unusual. Endovascular treatment is now the first-line, safest and cost-effective treatment for this type of fistula. In this paper, we report a very rare situation (a spontaneous posterior fossa dural arteriovenous fistula presenting clinically as a carotid-cavernous fistula) that is treated with endovenous intervention and coil embolization. The importance of other cavernous sinus-related fistulas, their diagnostic features and therapeutic options will also be discussed in this paper.

Dural Arteriovenous Fistula Presenting as Acute Unilateral Vestibulopathy

Intracranial dural arteriovenous fistula (dAVF) is characterized by an abnormal connection between branches of arteries and veins in the dura mater. Clinical manifestations of dAVF vary depending on their location, feeder arterial supply, amount of shunting, and most importantly, their venous drainage pattern. Acute vertigo has been rarely reported as an initial presentation of dAVF due to venous congestion in the brainstem. We report a patient who presented with acute right vestibulopathy without any brainstem signs in dAVF involving the transversesigmoid sinus. The patient showed abnormal caloric response but normal head impulse in the affected ear. Without any treatment, the patient’s symptoms gradually improved with a normalization of right canal paresis. Follow-up cerebral angiography also revealed a spontaneous regression of the shunt flow and reduction of venous drainage at the right transverse-sigmoid sinus. Based on the results of vestibular function tests and cerebral angiography, acute vertigo in our patient may be ascribed to impaired reabsorption of endolymph by focal venous congestion.

Abstract 12450: Mystifying Masquerade: Renal Cell Carcinoma Associated Arteriovenous Fistula Presenting as High-Output Heart Failure

Case Presentation: 59 year-old woman with CKD stage 3b and hypertension presented with 3 months of progressive dyspnea, abdominal distension, bilateral lower extremity edema, and a 60-pound weight gain. Physical exam noted diffuse anasarca, with stable hemodynamics on room air. EKG revealed low voltage leads and chest X-ray demonstrated an enlarged cardiac silhouette. CT abdomen was remarkable for significant ascites, body wall edema, and a suspicious large right renal mass. Diagnostic paracentesis indicated cardiac ascites. Echocardiogram showed preserved ejection fraction, moderate pericardial effusion and an enlarged right side of the heart. Right heart catheterization confirmed high-output heart failure (HOHF). A suspected renal mass-related arteriovenous fistula (AVF) was confirmed through inferior vena caval and renal venogram blood gas sampling, indicating arteriovenous shunting within the renal mass. Hepatic venogram excluded portal hypertension. MRI abdomen confirmed a large necrotic right renal mass consistent with renal cell carcinoma (RCC). Symptoms significantly improved after nephrectomy, with aggressive diuresis, and therapeutic paracenteses leading to an 80-pound weight loss. Postoperative echocardiography illustrated decrease in pericardial effusion and right ventricular size. Cardiac MRI and stress test were unremarkable prior to planned immunotherapy for stage III RCC. Discussion: AVF and HOHF associated with malignancy are unusual presentations. RCC is the most prevalent underlying malignancy linked with AVF and is hypothesized to be a result of hypervascularity caused by a VHL gene mutation. The most often utilized imaging modalities for detecting a tumor-related AVF are contrast enhanced CT or MRI. When imaging is inconclusive, a venogram with blood gas sample, as observed in our case, may be considered to establish an RCC-associated AVF.

Traumatic middle meningeal arteriovenous fistula presenting with long delayed-onset facial nerve palsy without temporal bone fracture: illustrative case.

Traumatic facial nerve palsy (FNP) without temporal bone fracture (TBF) has a delayed onset in some cases; however, long delayed-onset FNP in this setting has not been reported. The middle meningeal vein (MMV) is one of the venous drainage routes from the facial nerve. Herein, the authors describe a rare case of traumatic middle meningeal arteriovenous fistula (MMAVF) presenting with the long delayed-onset FNP without TBF. A 42-year-old man with pulsatile tinnitus and left FNP was admitted to our hospital 4 weeks after head trauma without TBF. Cerebral angiography revealed an MMAVF between the middle meningeal artery and the MMV on the left side. Seven days after admission, the FNP showed slight improvement, and preoperative angiography revealed decreased shunt flow of the MMAVF. Transarterial coil embolization was successfully performed. Postoperative angiography showed no residual fistula. Two weeks after the procedure, there was complete resolution of the FNP. This clinical course was correlated with the angiographic findings, suggesting that the long delayed-onset FNP was caused by the traumatic MMAVF without TBF. In patients presenting with long delayed-onset FNP after head trauma without TBF, the vascular lesion must be evaluated to exclude MMAVF.

Craniocervical Junction Dural Arteriovenous Fistula and Pial Arteriovenous Fistula Presenting Concomitantly in Separate Locations with Subarachnoid Hemorrhage

Craniocervical junction dural arteriovenous fistula and pial arteriovenous fistula are rare cerebrovascular lesions. While their pathophysiology is different, both conditions can cause intracranial hemorrhage attributable to venous congestion. We present, to our knowledge, the first case report of craniocervical junction dural arteriovenous fistula and pial arteriovenous fistula presenting concomitantly in separate locations with subarachnoid hemorrhage. This case appears to have been due to increased venous hypertension caused by a merging of the venous drainage of the 2 lesions, resulting in hemorrhage.

Therapy for Necrotic Fingertip Ischemia Secondary to Traumatic Arteriovenous Fistula

Background: This is the first report on an accidental arteriovenous fistula of the upper limb. We discuss in this publication the clinical presentation, diagnostic process and treatment options of arteriovenous fistula (AVF) that can be conservative and interventional. Case presentation: We are reporting a case of a 89-year old white man with a necrotic fingertip ischemia secondary to a traumatic AVF. A Doppler sonography showed an AVF between the metacarpal bones of the digits 1 and 2 and confirmed a hand and forearm vein dilation. A fistula ligation would be indicated as first-line therapy, which was rejected by the elderly multimorbid patient. Owning to risk of potential wound healing problems, lifetime medical management such as manicure of the right index is recommended. In case of injury, compression therapy should be performed. The follow up was without complication. Conclusion: A fistula ligation is the therapy of choice in a patient with an arteriovenous fistula of the upper limb.

Syringomyelia secondary to thoracic spinal dural arteriovenous fistula presenting as paraparesis.

Spinal dural arteriovenous fistula (SDAVF) is also known as a type 1 spinal arteriovenous malformation, representing the most frequent vascular malformation of the spine. A high suspicion index is often required for the initial diagnosis of SDAVF because of subtle magnetic resonance imaging signs. We present the case of a patient with SDAVF associated with syringomyelia of the thoracic spinal cord and hypothesize that a fistula might induce intramedullary fluid accumulation due to venous hypertension, which leads to syrinx formation.

Dural arteriovenous fistula presenting with stroke-like symptoms and regional cerebral hyperperfusion: a case report

BackgroundNon-hemorrhagic focal neurological deficit is one of the clinical manifestations of intracranial dural arteriovenous fistulas (DAVF). When symptoms appear suddenly, it is difficult to distinguish it from ischemic stroke in certain circumstances, which might easily lead to misdiagnosis. Here, we report a rare case of DAVF with sudden onset sensory aphasia mimicking hyperacute stroke but presented with unexpected regional hyperperfusion on the site corresponding to its symptoms.Case presentationA 76-year-old male with histories of atrial fibrillation and hypertension was admitted to the emergency department due to sudden sensory aphasia. The diagnosis of ischemic stroke was made based on clinical experience after non-contrast CT excluding hemorrhage. As in the absence of clear contraindication, the patient received intravenous thrombolysis. On the cerebral CT perfusion, the left temporal lobe, where the sensory speech center is located, was manifested as regional hyperperfusion. Thrombolysis was subsequently halted, but scheduled cranial imaging indicated hemorrhagic transformation. According to the radiological hint from cranial MRI, the patient was suspected of having DAVF, which was finally confirmed by cerebral digital subtraction angiography.ConclusionWhen DAVF is presented as sudden onset focal neurological deficit, cranial CT perfusion at an early stage might reveal an abnormal hyperperfusion pattern. Clinicians should be aware of the diagnostic possibility of DAVF in this situation and double-review the CT angiography image to reduce missed diagnoses.

Aural Arteriovenous Fistulas Presenting as Symmetric Lesions in the Internal Capsule on Imaging Studies: A Case Report and Literature Review.

Dural arteriovenous fistulas (DAVFs) leading to oedema, primarily in the internal capsule, are extremely rare and, to our knowledge, have never been reported. We reported a case of DAVFs with oedema in bilateral internal capsule oedema and reviewed the literature. The report describes a unique imaging presentation of cases of DAVFs as symmetric lesions, mainly in the bilateral internal capsule. It also reviews the literature for symmetric lesions in the internal capsule and central grey matter caused by DAVFs to further characterize this rare entity and differential diagnosis through imaging features. In cases of symmetric oedema caused by DAVFs, the most common artery involved in arterial supply was the middle meningeal artery (13/24; 54%). The main vein involved in the drainage was the Galen vein (18/29; 62%). Most cases were treated with transarterial embolization (23/29; 79%), and the probability of effective treatment or complete cure is 100%. On imaging, the vasogenic oedema signal caused by DAVFs is a symmetrical lesion of the bilateral internal capsule, that is, DWI MRI shows a high signal in the unrestricted diffusion area on the apparent diffusion coefficient map. MR has good diagnostic value in abnormal basal ganglia symmetric signals caused by DAVFs, and can quickly identify DAVFs early.

Hybrid management of lower limb huge pseudoaneurysm with arteriovenous fistula presenting 8 years after gunshot injury

All over the world, except during the war period, firearm injuries are encountered in daily life at varying rates depending on the region and country. In addition, late-term vascular complications may occur in injuries with a less traumatic appearance. In this present case report, we aimed to evaluate the hybrid treatment of giant pseudoaneurysm and arteriovenous fistula (AVf) in the left superficial femoral artery (SFA), which developed in a patient who had a pellet shot on his left thigh eight years ago. Postsurgical management was straightforward; the patient received antibiotherapy with ampicillin and sulbactam acid for 7 days, acetylsalicylic acid 100mg per day, and anticoagulant treatment with low molecular weight heparin for 1 month. The patient was examined in the cardiovascular surgery polyclinic on the 5th day after discharge uneventfully. Although endovascular treatment methods are widely used today in the treatment of vascular injuries, surgery still maintains its importance. In some special patient groups, a combination of these two treatment methods may be preferred.

Abstract Number ‐ 280: A Unique Case of Pial AVF Presenting as Hemispheric Cerebral Edema

Introduction To describe a unique case of pial arteriovenous fistula presenting as left hemispheric cerebral edema with hemianopsia, sensory change and ataxia. Methods Case report Results Our patient is a 38 year old male with a history of diabetes, hyperlipidemia and congenital deafness with a left cochlear implant who presented to an outside hospital for visual complaints. Non‐contrast CT of the head was negative at that time; he could not obtain an MRI due to his cochlear implant. He developed worsening right hemianopia and aphasia, prompting his transfer to our facility. Upon arrival, repeat imaging was done, including a CTA of the head and neck. This revealed a large region of hypodensity involving the left PCA and distal MCA territories. An MRI was attempted but artifact from his implant obscured visualization of the left hemisphere. Post‐contrast CT was negative for evidence of tumor. CT venogram was negative for veno‐occlusive disease. He complained of worsening headache and demonstrated worsening word‐finding ability. He received100g total of mannitol divided across 3 boluses which improved his symptoms mildly. Over the following days he began to become ataxic and clumsy in the right upper extremity and his headache worsened further and he began to develop focal seizures electrographically localized to the left parietal lobe. Repeat CTA demonstrated expanding hypodensity with marked vascular engorgement in the left hemisphere. He underwent 6‐vessel digital subtraction angiography (DSA) of the head which revealed gross left hemispheric venous congestion with early filling of the left hemispheric venous system by a parasagittal pial ateriovenous fistula believed to be responsible for his hemispheric edema. He was discharged on acetazolamide and acetaminophen for headache management and plans for outpatient follow‐up and potential intervention. Follow‐up DSA revealed improvement in his venous congestion and reduction in the degree of his early venous filling with some symptomatic improvement by medical management. Conclusions Pial arteriovenous fistulae (pAVF) are a rare entity and can present in a variety of ways, with symptomatic intracranial hemorrhage and ischemia being two of the most common. This case illustrates an unusual instance of hemispheric edema initially mistaken for venous infarct caused by a pAVF, and prompts the physician to consider angiography and further exploration when initial workup for cerebral edema and/or venous infarct is initially unrevealing.

Endovascular embolization and needle aspiration of a life-threatening cervical hematoma due to a neurofibromatosis type 1-associated arteriovenous fistula: illustrative case.

In cases of neurofibromatosis in which the bleeding source is considered strongly related to a neurofibroma, an open surgical approach could risk uncontrollable bleeding from the vascular wall infiltration by neurofibroma. The case of a neurofibromatosis type 1 (NF1)-associated arteriovenous fistula presenting with a life-threatening cervical hematoma that was successfully treated with alternative treatment is described. A 68-year-old woman diagnosed with NF1 presented with sudden onset of a spontaneous right cervical mass. Neck imaging on admission showed a massive subcutaneous hematoma with tracheal deviation and abnormal vascular structure in the hematoma. Digital subtraction angiography showed that an arteriovenous fistula (AVF) fed from a vertebral artery located within the hematoma cavity was the primary source of bleeding and feeding arteries from the occipital artery to the neurofibroma. Embolization of the cervical neurofibroma, as well as the AVF, was performed to reduce the secondary risk of bleeding, and was accomplished. After endovascular treatment, needle aspiration of the cervical hematoma was performed to reduce the mass effect. When performing open surgery via tissues with neurofibromatosis proliferation, uncontrollable bleeding can occur. Therefore, endovascular embolization and needle aspiration of the hematoma should be considered in this setting.

Intracranial Dural Arteriovenous Fistula Presenting with Isolated Astereopsis.

Intracranial Dural Arteriovenous Fistula Presenting with Isolated Astereopsis.

Dural Arteriovenous Fistula Presenting as Pulsatile Tinnitus

Dural Arteriovenous Fistula Presenting as Pulsatile Tinnitus

A case of tentorial dural arteriovenous fistula presenting as acute subdural hemorrhage of the posterior fossa

テント部硬膜動静脈瘻（TDAVF）は，脳実質内出血やくも膜下出血で発症して脳実質損傷を生じることが多く，急性硬膜下血腫（ASDH）の単独発症は非常に稀である．今回我々は，後頭蓋窩ASDHで発症したTDAVFに対して，発症早期に直達手術にて転帰良好であった症例を経験したので報告する．症例は29歳男性，突然の頭痛と嘔吐を生じたため，当院に救急搬送された．頭部CTで右後頭蓋窩にASDHを認めた．脳血管撮影では右テント切痕部にシャント部があり，静脈逆流および静脈瘤の形成を有するTDAVFの所見を認めた．血管内治療では，シャント部へのマイクロカテーテルの誘導が困難で，直達手術によりシャント部の完全閉塞が得られた．脳実質損傷を伴わない後頭蓋窩ASDH単独発症のTDAVF患者では，血腫除去および導出静脈におけるシャント部の離断を同時に施行でき，かつ根治性が高い直達手術の有用性が示唆された．

Dural Arteriovenous Fistula Presenting With Decreased Arterial-Spin-Labeling on Magnetic Resonance Imaging.

HomeStrokeVol. 54, No. 3Dural Arteriovenous Fistula Presenting With Decreased Arterial-Spin-Labeling on Magnetic Resonance Imaging No AccessCase ReportRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessCase ReportRequest AccessFull TextDural Arteriovenous Fistula Presenting With Decreased Arterial-Spin-Labeling on Magnetic Resonance Imaging Prateek B. Thatikunta, MD, Lily W. Zhou, MD, MS and Sarah Lee, MD Prateek B. ThatikuntaPrateek B. Thatikunta Correspondence to: Prateek B. Thatikunta, MD, Stanford Neurological Sciences, MC 5235, 453 Quarry Rd, Palo Alto, CA. Email E-mail Address: [email protected] https://orcid.org/0000-0001-6542-2827 Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA (P.B.T., S.L.). Search for more papers by this author , Lily W. ZhouLily W. Zhou https://orcid.org/0000-0002-3064-0864 Division of Neurology and Vancouver Stroke Program, University of British Columbia, Vancouver, Canada (L.W.Z.). Search for more papers by this author and Sarah LeeSarah Lee https://orcid.org/0000-0002-8821-6636 Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA (P.B.T., S.L.). Search for more papers by this author Originally published16 Nov 2022https://doi.org/10.1161/STROKEAHA.122.040639Stroke. 2023;54:e69–e70"Dural Arteriovenous Fistula Presenting With Decreased Arterial-Spin-Labeling on Magnetic Resonance Imaging." Stroke, 54(3), pp. e69–e70FootnotesFor Sources of Funding and Disclosures, see page e69.Correspondence to: Prateek B. Thatikunta, MD, Stanford Neurological Sciences, MC 5235, 453 Quarry Rd, Palo Alto, CA. Email [email protected]edu

SUBDURAL HEMATOMA CAUSED BY DURAL ARTERIOVENOUS FISTULA: REPORT OF A RARE MANIFESTATION

Dural arteriovenous fistula (dAVF) presenting with acute subdural hematoma, which is not related to head injury, is rare. Dural arteriovenous fistula is the second most common type of cerebrovascular malformation that exhibits as arteriovenous shunting. We report a case of dural AVF presenting with acute subdural hematoma (ASDH) and provide a review of the literature. A 21-year-old man presented with headache on the left side, the only symptom that drove him to the hospital. Computed tomography demonstrated a small right ASDH. Cerebral angiography showed a dural AVF at bilateral temporal regions with the feeders from bilateral meningeal and temporal arteries draining into the cortical veins.

A Case of Dural Arteriovenous Fistula Presenting with Dizziness

A Case of Dural Arteriovenous Fistula Presenting with Dizziness