Dural Arteriovenous Fistula Presenting Research Articles

Simultaneous Parkinsonism and Dementia as Initial Presentation of Intracranial Dural Arteriovenous Fistulas: A Systematic Review

Intracranial dural arteriovenous fistulas (IDAVFs) are abnormal vascular connections between dural arteries and various venous structures within the brain. IDAVFs, rarely present with parkinsonism and dementia concurrently, making this a unique and underexplored clinical scenario. To the best of our knowledge, this is the first systematic review to comprehensively analyze cases of IDAVFs manifesting as both parkinsonism and dementia. We assessed databases from inception to September 18, 2023. We identified studies describing patients with IDAVFs initially presenting with dementia or parkinsonism. Inclusion criteria encompassed case reports and case series, while excluding review articles, guidelines, technical notes, comments, conference abstracts, and editorials. The systematic search resulted in the initial screening of 383 studies, with 33 articles meeting the inclusion criteria. Among these, 29 were case reports, often describing 3 or fewer patients. From the remaining 4 case series, data pertinent to patients presenting both parkinsonism and dementia were selectively extracted, yielding a total study population of 43 patients. The anatomical distribution of IDAVFs within this cohort was diverse, with the transverse and sigmoid sinuses being the most common locations. Although most of these patients received endovascular therapy, a few underwent microsurgical occlusion or combined surgical and endovascular treatment. IDAVFs presenting with both parkinsonism and dementia represent a rare clinical entity. This systematic review provides valuable insights into the clinical characteristics, treatment options, and outcomes for such cases. However, additional research involving larger cohorts is essential to better comprehend the underlying mechanisms and establish standardized therapeutic guidelines.

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.

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.

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.

Dural Arteriovenous Fistula Presenting as Pulsatile Tinnitus

Dural Arteriovenous Fistula Presenting as Pulsatile Tinnitus

Intracranial Dural Arteriovenous Fistula Presenting with Isolated Astereopsis.

Intracranial Dural Arteriovenous Fistula Presenting with Isolated Astereopsis.

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.

Progressive Cervical Myelopathy With Medullary Involvement as a Presentation of Dural Arteriovenous Fistula.

HomeStrokeVol. 53, No. 12Progressive Cervical Myelopathy With Medullary Involvement as a Presentation of Dural Arteriovenous Fistula No AccessCase ReportRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessCase ReportRequest AccessFull TextProgressive Cervical Myelopathy With Medullary Involvement as a Presentation of Dural Arteriovenous Fistula Francisco Millet Barros, MD, Rita Machado, MD, Diogo Carneiro, MD, Helena Gens, MD and Gustavo Cordeiro Santo, MD Francisco Millet BarrosFrancisco Millet Barros Correspondence to: Francisco Millet Barros, MD, Serviço de Neurologia, Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, 3004-561, Coimbra, Portugal. Email E-mail Address: [email protected] https://orcid.org/0000-0003-3962-3080 Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Portugal. Search for more papers by this author , Rita MachadoRita Machado https://orcid.org/0000-0003-3605-277X Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Portugal. Search for more papers by this author , Diogo CarneiroDiogo Carneiro https://orcid.org/0000-0001-8912-4736 Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Portugal. Search for more papers by this author , Helena GensHelena Gens Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Portugal. Search for more papers by this author and Gustavo Cordeiro SantoGustavo Cordeiro Santo https://orcid.org/0000-0002-8353-6913 Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Portugal. Search for more papers by this author Originally published27 Sep 2022https://doi.org/10.1161/STROKEAHA.122.040163Stroke. 2022;53:e515–e516"Progressive Cervical Myelopathy With Medullary Involvement as a Presentation of Dural Arteriovenous Fistula." Stroke, 53(12), pp. e515–e516FootnotesFor Disclosures, see page e516.Presented in part at the 8th Congress of the European Academy of Neurology, Vienna, Austria, June 25–28, 2022.Correspondence to: Francisco Millet Barros, MD, Serviço de Neurologia, Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, 3004-561, Coimbra, Portugal. Email [email protected]com

A Case of Dural Arteriovenous Fistula Presenting with Dizziness

A Case of Dural Arteriovenous Fistula Presenting with Dizziness

A case of a torcular dural arteriovenous fistula presenting with venous congestive encephalopathy

A Dural Arteriovenous Fistula (DAVF) is defined as an anastomosis between meningeal arteries and dural venous sinuses or cortical veins.

Reversible cognitive impairment and parkinsonism with leukoencephalopathy due to cranial dural arteriovenous fistula

Parkinsonism and rapid cognitive impairment may have many causes, but only a few have specific treatment. Cranial dural arteriovenous fistula (DAVF) represents 10-15% of intracranial arteriovenous malformations. Clinical manifestations depend on location and venous drainage. It is common the presence of pulsatile tinnitus, bruits and headache or headache and papilledema. Progressive cognitive decline is an unusual presentation due to bilateral thalamic edema or cortical venous hypertension. Endovascular or surgical treatment can reverse disease symptoms.We present a 74-year old man with rapidly progressive cognitive impairment and parkinsonism and a subsequent diagnosis of dural arteriovenous fistula (DAVF). Brain MRI revealed diffuse leukoencephalopathy probably attributable to elevated venous pressure. He was treated with partial embolization with Onix and left transverse sinus angioplasty. Following the procedure, there was a substantial reduction of venous pressure signs and remarkable clinical and imaging improvement, persisting at two years follow-up. This case represents an unusual presentation of DAVF. It is important to suspect the diagnosis of DAVF in cases with rapidly evolving cognitive impairment, parkinsonism and leukoencephalopathy as it can be reversible with early treatment. 

Dural arteriovenous fistula presenting as thalamic dementia: a case description with rare imaging findings.

Dural arteriovenous fistula presenting as thalamic dementia: a case description with rare imaging findings.

Risk of Early Versus Later Rebleeding From Dural Arteriovenous Fistulas With Cortical Venous Drainage.

Background:Cranial dural arteriovenous fistulas with cortical venous drainage are rare lesions that can present with hemorrhage. A high rate of rebleeding in the early period following hemorrhage has been reported, but published long-term rates are much lower. No study has examined how risk of rebleeding changes over time. Our objective was to quantify the relative incidence of rebleeding in the early and later periods following hemorrhage.Methods:Patients with dural arteriovenous fistula and cortical venous drainage presenting with hemorrhage were identified from the multinational CONDOR (Consortium for Dural Fistula Outcomes Research) database. Natural history follow-up was defined as time from hemorrhage to first treatment, rebleed, or last follow-up. Rebleeding in the first 2 weeks and first year were compared using incidence rate ratio and difference.Results:Of 1077 patients, 250 met the inclusion criteria and had 95 cumulative person-years natural history follow-up. The overall annualized rebleed rate was 7.3% (95% CI, 3.2–14.5). The incidence rate of rebleeding in the first 2 weeks was 0.0011 per person-day; an early rebleed risk of 1.6% in the first 14 days (95% CI, 0.3–5.1). For the remainder of the first year, the incidence rate was 0.00015 per person-day; a rebleed rate of 5.3% (CI, 1.7–12.4) over 1 year. The incidence rate ratio was 7.3 (95% CI, 1.4–37.7; P, 0.026).Conclusions:The risk of rebleeding of a dural arteriovenous fistula with cortical venous drainage presenting with hemorrhage is increased in the first 2 weeks justifying early treatment. However, the magnitude of this increase may be considerably lower than previously thought. Treatment within 5 days was associated with a low rate of rebleeding and appears an appropriate timeframe.

Long-term stability of Onyx: is there any indication for repeated angiography after dural arteriovenous fistula embolization?

The natural course of dural arteriovenous fistulas (DAVFs) is unfavorable. Transarterial embolization with Onyx is currently the therapeutic method of choice, although the long-term stability of Onyx has been questioned. The literature reports a significant difference in the recurrence rate after complete DAVF occlusion and lacks larger series with long-term follow-up. The authors present the largest series to date with a long-term follow-up to determine the stability of Onyx, prospectively comparing magnetic resonance angiography (MRA) and digital subtraction angiography (DSA) as follow-up diagnostic methods. Demographics, clinical symptomatology, length of follow-up, diagnostic methods, and angiographic findings of DAVFs were recorded and retrospectively evaluated in 112 patients. A prospective group of 15 patients with more than 5 years of follow-up after complete DAVF occlusion was established. All 15 patients in the prospective group underwent a clinical examination and MRA; 10 of these patients also underwent DSA. The recurrences and the correlation between the two diagnostic methods were evaluated. Among the 112 patients, 71 were men and 41 were women, with an average age of 60 years. Intracranial hemorrhage (40%) was the most common clinical presentation of DAVF. At the last follow-up, 73% of the patients experienced clinical improvement, 21% remained unchanged, and 6% worsened. Overall, 87.5% of the DAVFs were occluded entirely with endovascular treatment, and 93% of the DAVFs were classified as cured at the last follow-up (i.e., completely embolized DAVFs and DAVFs that thrombosed spontaneously or after Gamma Knife surgery). Two recurrences of DAVFs were recorded in the entire series. Both were first diagnosed by MRA and confirmed with DSA. The mean follow-up was 27.7 months. In the prospective group, a small asymptomatic recurrence was diagnosed. The mean follow-up of the prospective group was 96 months. Onyx is a stable embolic material, although recurrence of seemingly completely occluded DAVFs may develop because of postembolization hemodynamic changes that accentuate primarily graphically absent residual fistula. These residuals can be diagnosed with MRA at follow-up. The authors' data suggest that MRA could be sufficient as the follow-up diagnostic method after complete DAVF occlusion with Onyx. However, larger prospective studies on this topic are needed.

A Case of the Superior Sagittal Sinus Dural Arteriovenous Fistula Presenting with Papillary Edema and Visual Impairment

A Case of the Superior Sagittal Sinus Dural Arteriovenous Fistula Presenting with Papillary Edema and Visual Impairment