We report two patients with dural arteriovenous fistulas (DAVFs) who presented with pure progressive dementia. Both patients showed only slowly progressive dementia, without headache, papilledema and other neurologic signs associated with diffuse white matter changes in MRI. MR cerebral angiography showed sigmoid sinus DAVFs that were mainly supplied by the occipital artery, together with retrograde filling of the superior sagittal and straight sinus and dilated cortical veins. SPECT studies showed extensive blood flow reduction in the occipital and parieto-occipital areas and right temporal lobe in one patient. Selective embolization for treatment of the DAVF improved cognitive function associated with the abnormal white matter MRI signal. MRI and SPECT showed that severity of dementia correlated with diffuse white matter changes and regional cerebral blood flow. Our cases suggest that gradually impaired cerebral circulation due to venous hypertensive encephalopathy could be involved in slowly progressive dementia with leukoencephalopathy resulting from a DAVF. DAVFs may be particularly important for differential diagnosis in elderly patients with pure progressive dementia. Thus, early diagnosis of DAVFs and treatment by endovascular surgery is important as treatable or reversible dementia.

Believing that improved therapeutic results in cases of intracerebral hematoma might be obtained by minimal invasion of the brain, we used computed tomographic-guided stereotactic aspiration in 175 of 241 patients with putaminal hemorrhage. These patients, who were treated 6 or more hours after onset, had hematomas larger than 8 ml and were unable to raise an arm and/or leg on the affected side. Craniotomy was performed in 15 other patients, most of whom were brought to the hospital with large hematomas within 6 hours of onset. The remaining patients either had mild deficits of consciousness (33 patients) or severe deficits and/or were elderly (18 patients) and were treated conservatively. Thirteen patients (7.4%) showed rebleeding after stereotactic aspiration (6 instances of major and 7 instances of minor rebleeding). Craniotomy and removal of the hematoma were required in three of these patients. Aspiration should be avoided in patients who have a tendency for bleeding, even if mild, because rebleeding occurred in 6 of 23 such patients (26%) in these study. The consciousness level improved in 66 patients (38%), was unchanged in 103 patients (59%), and was worse in 6 patients (3%) 1 week postoperatively. Motor function of the arm improved in 55 patients (31%) and was worse in 23 patients (14%). Six months after surgery, the results for the 175 patients who underwent stereotactic aspiration were: 19% excellent, 32% good, 35% fair, 7% poor, 6% dead, and 1% unknown. For the entire series of 241 patients, the results were: 24% excellent, 26% good, 31% fair, 7% poor, 11% dead, and 1% unknown.(ABSTRACT TRUNCATED AT 250 WORDS)

We evaluated liver function and coagulation parameters in 117 patients with spontaneous intracerebral hemorrhage (68 men and 49 women) admitted to our clinic within 24 hours after onset. Liver dysfunction was more common among men than women due to differences in alcohol consumption. Number of thrombocytes and fibrinogen concentrations were lower, especially among men with elevated concentrations of glutamic oxaloacetic transaminase or glutamic pyruvic transaminase and/or elevated y-globulin fraction. Five of the 78 patients undergoing stereotactic hematoma aspiration and one of the 39 treated nonsurgically rebled. All six of the patients who rebled were men, heavy alcohol consumers with liver dysfunction. Fibrinogen concentration was abnormally low in four of the six and at the lower end of the normal range in one. Two showed thrombocytopenia and one case showed prolonged prothrombin time. These facts suggest that liver disorders produce a state in which hemorrhage occurs more readily and that this hemorrhagic tendency may be one of the causal factors of spontaneous intracerebral hemorrhage. A lthough hypertension is considered the cause L \ of bleeding in the majority of spontaneous A. \ . intracerebral hemorrhage cases, 1 -3 the existence of cases in which a hemorrhagic diathesis is the cause must be considered when deciding upon surgical therapy. Prior to November 1985, we performed computed tomography (CT)-guided stereotactic aspiration in 125 patients with intracerebral hematoma. 4 Among those patients, eight rebled subsequent to the surgery. When those patients in whom the rebleeding due to problems in postoperative care or the technique used for aspiration of the hematoma were excluded, there remained three patients with a history of liver disease.Those three patients drew our attention to the possible involvement of chronic liver disorders in spontaneous intracerebral hemorrhage and, specifically, to the possibility that patients might develop a tendency to bleed due to liver dysfunction. To clarify the degree to which such a tendency is involved in intracerebral hemorrhage, we studied alcohol consumption, liver function, and coagulation parameters in 117 patients admitted to our clinic with spontaneous intracerebral hemorrhage. Received August 13, 1987; accepted February 26, 1988. Subjects and MethodsBetween December 1985 and February 1987, we evaluated 202 patients with spontaneous intracerebral hemorrhage in whom diagnoses of aneurysm, arteriovenous malformation, or moyamoya disease had been excluded by cerebral angiography. Of those patients, 85 had been admitted to our clinic >24 hours after onset or had received incomplete examinations on admission. Therefore, only 117 patients met the criteria for this study. There were 68 men and 49 women. The men ranged in age from 30 to 77 (mean ± SD 54.9 ±9.9) years and the women from 33 to 84 (mean±SD 60.1 ±9.7) years. The sites of bleeding were the putamen in 66 patients, the thalamus in 38, the cerebellum in 6, the cerebral subcortex in 3, the caudate nucl...

A 75-year-old woman with a dural arteriovenous fistula (DAVF)

No abstract