Occipital Neuralgia As a Presenting Symptom of Cervicomedullary Dural Arteriovenous Fistula

Abstract

Dural arteriovenous fistulas (DAVFs) at the cervicomedullary junction are rare and have a wide variation in presentation. We report a case of occipital neuralgia (ON) as a rare presenting symptom of cervicomedullary DAVF causing intramedullary hemorrhage at the C1 level. It is important to consider the underlying causes of ON, and precise neurological examinations and radiological evaluations are needed.

Dural arteriovenous fistulas at the craniocervical junction: a systematic review

“…Myelopathy also remains the main presenting symptom. Atypical presentations included brainstem/cerebellar dysfunction,12 22 24–26 29 radiculopathy,5 cranial nerve palsy,23 and occipital neuralgia 30 31. Brainstem dysfunction as the initial symptom has often been reported in intracranial DAVFs, but is rarely documented in craniocervical DAVFs.…”

“…Occipital neuralgia is an extremely uncommon presentation of craniocervical DAVFs. Hashiguchi et al 30 thought that edema around the intramedullary hemorrhage might affect the incoming sensory fibers within the dorsal root entry zone and cause occipital neuralgia.…”

Dural arteriovenous fistulas draining into the petrosal vein or bridging vein of the medulla: possible homologs of spinal dural arteriovenous fistulas

“…We excluded DAVFs located in remote regions that drained into posterior fossa veins secondary to thrombosis of their "natural" outlets, in particular cavernous sinus or transversesigmoid lesions with venous occlusions. In the previously published literature, we found 30 cases of petrosal vein DAVFs 4,5,[7][8][9]13,16,21,30,33,[36][37][38]41,45,48,52,55,56,59,60 and 35 cases of medulla bridging vein DAVFs, 1,11,14,[17][18][19][20][22][23][24][25]31,32,35,39,40,43,46,50,51,53,58,61 all of which were well described with clinical and angiographic information. These previously reported cases were analyzed together, with special attention to their clinical characteristics.…”

Pulsed Radiofrequency for the Treatment of Occipital Neuralgia

“…Irritation of the occipital nerves often lies at the origin of the neuralgia. Reasons for this irritation are diverse, ranging from vascular compression by aberrant vessels, 3 giant cell arteritis, 4 compression by osteogenic tumors, 5 arthrosis, 6 callus formation after vertebral fractures, 7 schwannoma, 8 C2 myelitis, 9 or, as is most often the case, tendinomuscular compression. 10 Proposed treatments for ON include local injection therapy, 11 subcutaneous electrical stimulation of the occipital nerves, 12 acupuncture, 13 neurolysis of the occipital nerves, 14 dorsal root entry zone rhizotomy, 15 or even ganglionectomy.…”