Reversible dementia due to dural arteriovenous fistula: A simple surgical option

Datta, Narendra N.; Rehman, S.; Kwok, John Ching Kwong; Chan, Kwong‐Yau; Poon, Christopher Yee‐Fat

doi:10.1007/bf02389327

Cited by 18 publications

(12 citation statements)

References 11 publications

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“…Cortical dementia due to dAVF is characterized by rapidly progressive cognitive dysfunction including impairments in verbal fluency and language comprehension, apraxia, visuospatial discordance, and memory dysfunction that is frequently accompanied by focal cortical deficits including hemiparesis, somatic sensory disturbances, aphasia, alexia, and/or visual disturbances. 13,16,18,28,31,36,37,41,54,61,69,80,81,84,85,87,89 These symptoms are associated with widespread and/or multilobar hyperintensities on FLAIR and T2-weighted imaging. 31,41,54,82 Thalamic dementia due to dAVF is characterized by rapidly progressive cognitive dysfunction including disorientation, executive dysfunction, attention deficits, memory impairment, confabulation and disinhibition.…”

Section: Discussionmentioning

confidence: 99%

Dural arteriovenous fistula-induced thalamic dementia: report of 4 cases

Holekamp

Mollman

Murphy

et al. 2016

JNS

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Nonhemorrhagic neurological deficits are underrecognized symptoms of intracranial dural arteriovenous fistulas (dAVFs) having cortical venous drainage. These symptoms are the consequence of cortical venous hypertension and portend a clinical course with increased risk of neurological morbidity and mortality. One rarely documented and easily misinterpreted type of nonhemorrhagic neurological deficit is progressive dementia, which can result from venous hypertension in the cortex or in bilateral thalami. The latter, which is due to dAVF drainage into the deep venous system, is the less common of these 2 dementia syndromes. Herein, the authors report 4 cases of dAVF with venous drainage into the vein of Galen causing bithalamic edema and rapidly progressive dementia. Two patients were treated successfully with endovascular embolization, and the other 2 patients were treated successfully with endovascular embolization followed by surgery. The radiographic abnormalities and presenting symptoms rapidly resolved after dAVF obliteration in all 4 cases. Detailed descriptions of these 4 cases are presented along with a critical review of 15 previously reported cases. In our analysis of these 19 published cases, the following were emphasized: 1) the clinical and radiographic differences between dAVF-induced thalamic versus cortical dementia syndromes; 2) the differential diagnosis and necessary radiographic workup for patients presenting with a rapidly progressive thalamic dementia syndrome; 3) the frequency at which delays in diagnosis occurred and potentially dangerous and avoidable diagnostic procedures were used; and 4) the rapidity and completeness of symptom resolution following dAVF treatment.http://thejns.org/doi/abs/10.3171/2015.5.JNS15473Key words dural arteriovenous fistula; cortical venous hypertension; thalamic edema; nonhemorrhagic neurological deficit; thalamic dementia; vascular disorders ©AANS, 2016 davF-induced thalamic dementiaBorden-Shucart classification system-based not only on angiographic appearance but also mode of presentationto permit more accurate risk stratification and assist with clinical decision making for the type and timing of dAVF treatment (Table 1). 68,91One relatively underappreciated type of NHND is progressive dementia resulting from dAVF-induced cortical venous hypertension, though correct diagnosis and treatment is increasing, thanks to improved imaging techniques.18,79 Dural AVF-induced progressive dementia can be differentiated as either cortical or thalamic in origin-2 categories that have relatively distinct patterns of clinical symptomatology 18,54,62,80,85 and highly specific venous outflow patterns.18,80 Of the two, dAVFinduced thalamic dementia is less frequent, with only 15 published cases reported in the literature to date. All were individual case reports, and several lacked adequate clinical, radiographic, and/or treatment specifics to permit detailed assessment as to manner of presentation, underlying hemodynamic pathophysiology, and long-term outcome. 18,[21][22][23]...

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Section: Discussionmentioning

confidence: 99%

Dural arteriovenous fistula-induced thalamic dementia: report of 4 cases

Holekamp

Mollman

Murphy

et al. 2016

JNS

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“…Local symptomatology (which can be progressive) at the site of the fistula, congestional (often recurring) bleeding (sometimes into the subdural or subarachnoid space) because of venous overload, and venous hypertensive encephalopathy (Datta et al. , 1998; Hurst et al.…”

Section: Discussionmentioning

confidence: 99%

Intracranial arterial and arteriovenous malformations presenting with infarction. Lausanne Stroke Registry study*

Herzig¹,

Bogousslavsky²,

Maeder

et al. 2005

Euro J of Neurology

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Cerebral aneurysms and arteriovenous malformations (AVMs) are well-known sources of intracranial hemorrhage, but can also manifest as other clinical symptoms or remain clinically asymptomatic. The aim was to document and analyze cases of aneurysm or AVM with brain infarction. Survey on 4804 stroke patients treated at the Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland between 1978 and 2000 using the Lausanne Stroke Registry. Twenty patients presented with cerebral aneurysm and 21 with cerebral AVM. Hemorrhage was present in 100% of the AVM and in 75% of the aneurysm patients; in one (5%) of the remaining aneurysm patients, aneurysm and infarction were located in different territories. Infarction associated with Sylvian artery aneurysm was found in three (15%), vertebrobasilar ischemia because of fusiform left vertebral artery aneurysm in one (5%), and dural fistula draining to the distal transversal and left sigmoid sinus associated with a stroke in the territory of the left anterior inferior cerebellar artery in one patient. Ischemic stroke is infrequent, but important, complication in unruptured intracranial aneurysms and AVMs. The early recognition and therapy of these vascular malformations in selected patients can avoid a major neurological deficit or death caused by their rupture.

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“…Venous congestion of the bilateral frontal lobes due to a superior sagittal sinus dural AVF can cause dementia, a rare but important symptom (59). The dementia can be misdiagnosed as a psychogenic or degenerative disorder but can be cured after treatment of the dural AVF.…”

Section: Superior Sagittal Sinus Dural Avfsmentioning

confidence: 99%