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

Neurographics ◽  
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.

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

2012 ◽  
Vol 32 (5) ◽  
pp. E10 ◽  
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.

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

Open Medicine ◽  
2014 ◽  
Vol 9 (2) ◽  
pp. 302-305
Author(s):  
Srdjan Ljubisavljevic ◽  
Dragan Stojanov ◽  
Mirjana Spasic ◽  
Miroslava Zivkovic
Keyword(s):  
Cavernous Sinus ◽  
Clinical Presentation ◽  
Arterial System ◽  
New Daily Persistent Headache ◽  
Arteriovenous Fistulas ◽  
Clinical Presentations ◽  
Wide Range ◽  
Dural Arteriovenous Fistulas ◽  
Carotid Cavernous Fistulas ◽  
Persistent Headache

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.

Magnetic resonance imaging findings in treated spinal dural arteriovenous fistulas: lack of correlation with clinical outcomes

2011 ◽  
Vol 14 (4) ◽  
pp. 548-554 ◽  
Author(s):  
Timothy J. Kaufmann ◽  
Jonathan M. Morris ◽  
Andrea Saladino ◽  
Jay N. Mandrekar ◽  
Giuseppe Lanzino
Keyword(s):  
Spinal Cord ◽  
Mr Imaging ◽  
Clinical Outcomes ◽  
Imaging Findings ◽  
Urinary Function ◽  
Arteriovenous Fistulas ◽  
Imaging Characteristics ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas

Object Little information is available on follow-up MR imaging after treatment of spinal dural arteriovenous fistulas (DAVFs). The authors studied MR imaging findings in treated spinal DAVFs in relation to clinical outcomes. Methods A retrospective review of patients with spinal DAVFs who had undergone both pre- and postoperative spinal MR imaging was conducted. Postoperative MR images were obtained as routine follow-up studies or because of subjective or objective clinical deterioration. Several pre- and posttreatment MR imaging characteristics were evaluated by 2 neuroradiologists blinded to the clinical outcome. Clinical outcomes of motor, sensory, and urinary function (in relation to the patient's preoperative status) at the time of the postoperative MR imaging were obtained from the clinical record. The chi-square, Fisher exact, and rank-sum tests were performed to correlate imaging findings and changes with clinical outcomes. Results Thirty-four patients met inclusion criteria. Treatment was surgical in 33 patients and endovascular in 1 patient. Follow-up MR imaging was performed at a mean 168 ± 107 days after treatment. Twenty-seven patients (79.4%) were either clinically stable or improved, and 7 (20.6%) experienced worsening in one or more clinical outcomes. Most patients were found to have improvement of MR imaging changes. However, some degree of persistent spinal cord signal abnormality, enhancement, and swelling was observed in 31 (91.2%), 29 (85.3%), and 18 (52.3%) patients, respectively. Changes in these MR imaging characteristics compared with preoperative MR imaging did not correlate with clinical outcomes (p > 0.05), with the one exception of a significant correlation between change in urinary function and extent of spinal cord contrast enhancement (p = 0.026), a correlation of uncertain importance. Ten of the 34 patients underwent posttreatment digital subtraction angiography, and 3 of these patients had recurrent/residual DAVFs. Worsening of motor function significantly correlated with recurrent/residual DAVF (p = 0.053). Conclusions Spinal cord abnormalities persist on postoperative MR imaging studies in patients with treated spinal DAVFs, and although they tend to mildly improve with time, these changes may not correlate with clinical outcomes. However, regardless of imaging findings, worsening motor function may correlate with a recurrent or residual DAVF.

Foramen Magnum Dural Arteriovenous Fistulas: Clinical Presentations and Treatment Outcomes, A Case-Series of 12 Patients

2017 ◽  
Vol 15 (3) ◽  
pp. 262-269 ◽  
Author(s):  
Mogwale S Motebejane ◽  
In Sup Choi
Keyword(s):  
Posterior Fossa ◽  
Intracranial Hemorrhage ◽  
Case Series ◽  
Foramen Magnum ◽  
Arteriovenous Fistulas ◽  
Progressive Myelopathy ◽  
Venous Sinuses ◽  
Clinical Presentations ◽  
Dural Arteriovenous Fistulas ◽  
Operative Notes

Abstract BACKGROUND Dural arteriovenous fistulas (DAVFs) are usually seen in relation to the venous sinuses, but in certain rare instances fistulas may not drain directly into the venous sinuses but rather drain into the cortical veins. This rare form of DAVF may present with either intracranial hemorrhage or myelopathy. The mode of clinical presentation is influenced by the venous outflow into either intracranial drainage or caudally intraspinal drainage. OBJECTIVE To evaluate the clinical presentations, angioarchitectural characteristics, and treatment of 12 patients who presented with DAVF in the region of the foramen magnum. METHODS In this case series we reviewed clinical charts, radiological images, and operative notes of 12 patients who were diagnosed of foramen magnum DAVF from December 1993 until April 2017. The angiographic studies were analyzed for feeding arteries, the location of the shunt, the venous drainage patterns, and the presence of venous side aneurysms. RESULTS Twelve patients were angiographically confirmed with foramen magnum DAVFs. They included 11 males and 1 female (M:F = 11:1). Mean age of 55.6 yr ranging between 42 yr and 71 yr of age. Eight patients presented with progressive myelopathy, 3 patients with posterior fossa intracranial hemorrhage, and 1 patient presented with lower cranial nerve IX and XII palsies due to mass effect. CONCLUSION A dural arteriovenous shunt, which may be located in the region of the foramen magnum, should be suspected in those cases of subarachnoid hemorrhage in the posterior fossa or progressive myelopathy mimicking spinal DAVF.

scholarly journals MR Selective Flow-Tracking Cartography: A Postprocessing Procedure Applied to Four-dimensional Flow MR Imaging for Complete Characterization of Cranial Dural Arteriovenous Fistulas

Radiology ◽  
2014 ◽  
Vol 270 (1) ◽  
pp. 261-268 ◽  
Author(s):  
Myriam Edjlali ◽  
Pauline Roca ◽  
Cécile Rabrait ◽  
Denis Trystram ◽  
Christine Rodriguez-Régent ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Complete Characterization ◽  
Arteriovenous Fistulas ◽  
Dimensional Flow ◽  
Dural Arteriovenous Fistulas

Dural arteriovenous fistulas as a relative contraindication for lumbar puncture: brief report and literature review

2019 ◽  
pp. 1-4
Author(s):  
Mohammad Ghorbani ◽  
Maziar Azar ◽  
Hamidreza Shojaei ◽  
Christoph J. Griessenauer ◽  
Grace DeHoff ◽  
...  
Keyword(s):  
Literature Review ◽  
Lumbar Puncture ◽  
Arteriovenous Fistulas ◽  
Relative Contraindication ◽  
Dural Arteriovenous Fistulas

Volumetric myelographic magnetic resonance imaging to localize difficult-to-find spinal dural arteriovenous fistulas

2011 ◽  
Vol 14 (3) ◽  
pp. 398-404 ◽  
Author(s):  
Jonathan M. Morris ◽  
Timothy J. Kaufmann ◽  
Norbert G. Campeau ◽  
Harry J. Cloft ◽  
Giuseppe Lanzino
Keyword(s):  
Magnetic Resonance Imaging ◽  
Steady State ◽  
Magnetic Resonance ◽  
Mr Imaging ◽  
Mr Angiography ◽  
Three Dimensional ◽  
Resonance Imaging ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas

Although more prevalent in males in the 6th and 7th decade of life, spinal dural arteriovenous fistulas (SDAVFs) are an uncommon cause of progressive myelopathy. Magnetic resonance imaging and more recently Gd bolus MR angiography have been used to diagnose, radiographically define, and preprocedurally localize the contributing lumbar artery. Three-dimensional myelographic MR imaging sequences have recently been developed for anatomical evaluation of the spinal canal. The authors describe 3 recent cases in which volumetric myelographic MR imaging with a 3D phase-cycled fast imaging employing steady state acquisition (PC-FIESTA) and a 3D constructive interference steady state (CISS) technique were particularly useful not only for documenting an SDAVF, but also for providing localization when CT angiography, MR imaging, MR angiography, and spinal angiography failed to localize the fistula. In a patient harboring an SDAVF at T-4, surgical exploration was performed based on the constellation of findings on the PC-FIESTA images as well as the fact that the spinal segments leading to T-4 were the only ones that the authors were unable to catheterize. In a second patient, who harbored an SDAVF at T-6, after 2 separate angiograms failed to demonstrate the fistula, careful assessment of the CISS images led the authors to focus a third angiogram on the left T-6 intercostal artery and to perform superselective microcatheterization. In a third patient with an SDAVF originating from the lateral sacral branch, the PC-FIESTA sequence demonstrated the arterialized vein extending into the S-1 foramen, leading to a second angiogram and superselective internal iliac injections. The authors concluded that myelographic MR imaging sequences can be useful not only as an aid to diagnosis but also for localization of an SDAVF in complex cases.

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