Neurointervention.  2017 Mar;12(1):50-53. 10.5469/neuroint.2017.12.1.50.

Dural Arteriovenous Fistula Manifested as Rapid Progressive Dementia Successfully Treated by Endovascular Embolization Only

• Hwang H
• La YK
• Baek MS
• Baik K
• Suh SH
• Kim WJ

• KMID: 2371759
• DOI: http://doi.org/10.5469/neuroint.2017.12.1.50

Abstract

A 43-year-old male presented with daytime sleepiness at work and indifferent behavior like never before. Two weeks prior to hospital admission, he had episodic memory loss with well preserved remote memory. Brain MRI showed a dural arteriovenous fistula (DAVF) in the right lateral transverse sinus with a bilateral thalamic venous infarction. Cerebral angiography confirmed a right transverse sigmoid dural arteriovenous fistula with a feeding artery of the right occipital artery and left posterior meningeal artery. The DAVF was completely eliminated through multiple endovascular interventions. Recently, endovascular treatment has become one of the main therapeutic options to obliterate a fistulous site, which has led to a rapid diagnostic approach and management of DAVFs with high curative rates. We report a rare case of posterior fossa located at a dural arteriovenous fistula that caused rapid progressive dementia and was successfully eliminated through only endovascular treatment.

Keyword

Dural arteriovenous fistula; Dementia; Therapeutic embolization

MeSH Terms

Adult
Arteries
Brain
Central Nervous System Vascular Malformations*
Cerebral Angiography
Colon, Sigmoid
Dementia*
Embolization, Therapeutic
Humans
Infarction
Magnetic Resonance Imaging
Male
Memory, Episodic
Memory, Long-Term
Meningeal Arteries

Figure

• 

  Fig. 1 Brain magnetic resonance imaging (MRI) shows a DAVF in the right lateral sinus with numerous feeding arteries in the posterior fossa (A). Cerebral angiography coronal view (B) and sagittal view (C) shows a right transverse sigmoid DAVF with a feeding artery of the right occipital artery and left posterior meningeal artery. Embolization was performed through two transmastoid feeders from the left occipital artery (white arrow)(D). Additional DAVF embolization was performed in the remnant fistulas of the right middle meningeal artery and left ICA-hypophyseal trunk via the right middle meningeal artery (white arrowhead)(E). Initial brain MRI shows a bilateral thalamic T2 signal change (F).

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