Endovascular management of six simultaneous intracranial dural arteriovenous fistulas in a single patient

A 64-year-old man with a history of traumatic brain injury 4 years previously presented with progressive cognitive decline and gait abnormality. MRI revealed diffusion restriction in the bilateral centrum semiovale and multiple serpiginous flow voids. Cerebral angiogram revealed a total of six intra...

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Bibliographic Details
Published in:BMJ case reports 2013-03, Vol.2013, p.bcr2012010619
Main Authors: Gist, Taylor L, Rangel-Castilla, Leonardo, Krishna, Chandan, Roman, Gustavo C, Cech, David A, Diaz, Orlando
Format: Article
Language:English
Subjects:
Carotid arteries
Central Nervous System Vascular Malformations - diagnosis
Central Nervous System Vascular Malformations - surgery
Cerebral Angiography
Classification
Endovascular Procedures
Head and Neck
Humans
Hypertension
Magnetic Resonance Imaging
Male
Middle Aged
Patients
Sinuses
Thrombosis
Veins & arteries
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Summary:A 64-year-old man with a history of traumatic brain injury 4 years previously presented with progressive cognitive decline and gait abnormality. MRI revealed diffusion restriction in the bilateral centrum semiovale and multiple serpiginous flow voids. Cerebral angiogram revealed a total of six intracranial dural arteriovenous fistulas with separate fistulas of the right and left sphenoid bones, left clival plexus, right transverse sinus, right sigmoid sinus, and superior sagittal sinus. A diffuse pseudophlebitic pattern of venous drainage indicating severe venous hypertension was also observed. The patient underwent a series of endovascular treatments over the next 10 months to achieve resolution of all arteriovenous shunting. Repeat MRI showed resolution of the diffusion restriction and marked reduction in T2 vascular flow voids. The patient's clinical status improved significantly over the course of treatment, paralleling the improvement in venous hypertension.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2012-010619