A Case of Cavernous Sinus Dural Arteriovenous Fistula Presenting with Medulla Oblongata Dysfunction in Parallel to Thrombosis of a Varix on a Drainage Route after Transvenous Embolization

Abstract

We report a case of cavernous sinus dural arteriovenous fistula (CSdAVF) presenting with medulla oblongata dysfunction in parallel to thrombosis of a varix on a drainage route after transvenous embolization (TVE). Case Presentation: A 76-year-old male presented with deep sensory disturbance. Cerebral angiogram revealed a right CSdAVF with retrograde venous drainage refluxing to the anterior medullary vein. A varix arising from the vein was buried in the medulla oblongata, and an edematous change was shown in the nerve tissue around the varix. TVE was successfully performed and the shunt flow completely disappeared. The neurological symptoms improved immediately after TVE. The following day after TVE, medulla oblongata dysfunction appeared again, which was more severe than that before TVE. MRI showed thrombosis and a volume increase of the varix, and an enlargement of edematous change in the nerve tissue around the varix. Administration of corticosteroids gradually improved neurological and imaging findings. Conclusion: A varix on a drainage route can cause brainstem dysfunction in CSdAVF. Thrombosis of the varix may exacerbate neurological symptoms. Keywords▶ cavernous sinus dural arteriovenous fistula, transvenous embolization, varix, thrombosis, medulla oblongata dysfunction