Intracranial Dural Arteriovenous Fistula With Venous Reflux to the Brainstem and Spinal Cord Mimicking Brainstem Infarction-Case Report-

Li, Jun; Ezura, Masayuki; Takahashi, Akira; Yoshimoto, Takashi

doi:10.2176/nmc.44.24

Cited by 42 publications

(31 citation statements)

References 18 publications

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“…6,14,16,18,19,21) The affected transverse-sigmoid sinuses showed some venous restriction in all cases, and isolated sinus, as in the present case, was observed in 3 cases. 6,18,21) The venous drainage descended into the cervical spinal perimedullary veins through the SPS in 2 cases.…”

Section: Discussionsupporting

confidence: 67%

“…16,21) However, the drainage patterns were not described in the other 4 cases. 6,14,18,19) The venous draining pattern in the present case reached the lateral medullary vein through the bridging vein at the distal end of the isolated sigmoid sinus, and descended into the spinal veins. Such a draining pattern is extremely rare, possibly because the bridging vein is not usually observed.…”

Section: Discussionmentioning

confidence: 48%

“…Cerebral dural AVFs with spinal perimedullary venous drainage generally manifest as symptoms of ascending myelopathy. 1,6,14,18,19) Neurological symptoms related with brainstem disturbance only occur in the late phase. 1,6,14,19) Only 3 patients presented with only neurological symptoms related to brainstem disturbance and no symptoms caused by myelopathy.…”

Section: Discussionmentioning

confidence: 99%

“…1,6,14,18,19) Neurological symptoms related with brainstem disturbance only occur in the late phase. 1,6,14,19) Only 3 patients presented with only neurological symptoms related to brainstem disturbance and no symptoms caused by myelopathy. 13,16,19) Table 1 summarizes the clinical data of those cases and the present case.…”

Section: Discussionmentioning

confidence: 99%

“…2) Only a few cases of the type V dural AVF have been reported, most commonly located in the tentorium cerebelli, foramen magnum, and superior petrosal sinus. 2,6,13,14,16,18,19,21) Most patients with type V dural AVF presented with myelopathy, 1,6,14,18) whereas neurological deficits based on brainstem disturbance are rare. 13,16,19) Type V dural AVF of the transverse-sigmoid sinus is extremely rare.…”

Section: Introductionmentioning

confidence: 99%

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Sigmoid Sinus Dural Arteriovenous Fistula With Spinal Venous Drainage Manifesting as Only Brainstem-Related Neurological Deficits Without Myelopathy -Case Report-

Sugiura¹,

Nozaki²,

Sato³

et al. 2009

Neurol. Med. Chir.(Tokyo)

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A 69-year-old woman presented with an extremely rare sigmoid sinus dural arteriovenous fistula (AVF) with venous drainage into a spinal perimedullary vein manifesting only as brainstem dysfunction without myelopathy. Cerebral angiography showed retrograde venous drainage into both the brainstem and spinal cord through the ipsilateral bridging vein from the affected isolated sigmoid sinus. Magnetic resonance (MR) imaging showed a hyperintense lesion in the medulla oblongata and lower pons with increased apparent diffusion coefficient (ADC), and enhancement with contrast material. The dural AVF was successfully treated by transfemoral transvenous embolization from the contralateral side, but the hyperintense area and neurological symptoms persisted after the treatment. The neurological deficits were probably due to venous hypertension associated with accessory retrograde venous drainage into the brainstem. MR imaging enhancement of the lesion may be more closely related to the prognosis of neurological deficits than the ADC value.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 48%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Sigmoid Sinus Dural Arteriovenous Fistula With Spinal Venous Drainage Manifesting as Only Brainstem-Related Neurological Deficits Without Myelopathy -Case Report-

Sugiura¹,

Nozaki²,

Sato³

et al. 2009

Neurol. Med. Chir.(Tokyo)

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Spinal Angiography

Harrigan¹,

Deveikis²

2009

Handbook of Cerebrovascular Disease and Neurointerventional Technique

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Spinal Angiography

Harrigan

Deveikis

2012

Handbook of Cerebrovascular Disease and Neurointerventional Technique

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Catheter angiography of the spine is much less common than cerebral angiography, but it remains the gold standard for imaging spinal vasculature. Non-invasive imaging of spinal vasculature, including high resolution MRA or CTA, can sometimes be helpful to screen for larger vascular abnormalities, but fails to provide precise information regarding fl ow patterns and collateral fl ow; many times the vessels of interest are below the spatial resolution of these non-invasive modalities. Diagnostic spinal angiography is also typically done as the fi rst step during neurointerventional procedures involving the spine and spinal cord. The techniques and skills required for spinal angiography can overlap those required for cerebral angiography, since the upper cervical spine and spinal cord are supplied by the vertebral arteries. However, the spine extends from the base of the skull to the sacrum, and imaging the vasculature is a procedure entirely different from cerebral angiography. Indications1. Evaluation of patients with myelopathy, suspected to have spinal dural arteriovenous fi stulas (most common indication). 2. Evaluation of patients with known or suspected spinal arteriovenous malformations or vascular neoplasms (e.g., with spinal intramedullary or subarachnoid haemorrhages). 3. Rarely for evaluation of suspected spinal cord ischemia ischaemia (since cord blood supply is so variable, and treatment options for cord ischaemia are so limited, angiography is mainly done to rule out a fi stula as the cause of symptoms). 4. Planning for neurointerventional procedures on spine or spinal cord. 5. Pre-op mapping of cord vasculature prior to spinal or aortic procedures that risk occlusion of the spinal vessels. 6. Intra-operative assistance with surgery on spinal vascular lesions. 7. Follow-up imaging after treatment (e.g., after treatment of arteriovenous fi stulas or malformations). Complications of Diagnostic Spinal AngiographyInformed consent prior to an angiogram should include a discussion of the risk of complications. Neurological ComplicationsNeurological complications in spinal angiography may include the same risk of cerebral ischaemic events that may occur during cerebral angiography when the cervical region is being studied (see Chap. 2 ). In addition, there is the risk of vessel dissection, embolic occlusion with thrombus, atherosclerotic plaque, or air emboli occluding the spinal cord vessels and producing myelopathy. Forbes et al. reported that a series of 134 spinal angiograms had three (2.2%) neurological complications, all transient. spinal cord (although not necessarily performed as part of spinal angiography) has also been shown to produce temporary or permanent injury to the spinal cord. 4-6 Non-neurological ComplicationsNon-neurological complications of spinal angiography via the femoral artery include the same local and systemic complications seen in cerebral angiography (as seen in Chap. 2 ). Forbes reported 8.2% puncture-site complications and 3.7% systemic complications from spinal angiography.1 ...

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Intracranial Dural Arteriovenous Fistula With Venous Reflux to the Brainstem and Spinal Cord Mimicking Brainstem Infarction-Case Report-

Cited by 42 publications

References 18 publications

Sigmoid Sinus Dural Arteriovenous Fistula With Spinal Venous Drainage Manifesting as Only Brainstem-Related Neurological Deficits Without Myelopathy -Case Report-

Sigmoid Sinus Dural Arteriovenous Fistula With Spinal Venous Drainage Manifesting as Only Brainstem-Related Neurological Deficits Without Myelopathy -Case Report-

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