DURAL ARTERIOVENOUS FISTULA AS A CAUSE OF BRAINSTEM EDEMA
Pei-Jung Chen, MD 1 ,
1 Neurological Institute, Shin Kong Wu Ho-Su Memorial Hospital
Li-Ming Lien , PhD
Neurological Institute, Shin Kong Wu Ho-Su Memorial Hospital
● A 73-year-old female with history of CC fistula presented with acute gait deviation to right. Admitted under the tentative diagnosis of stroke, weakness over limbs progressed and diagonal diplopia developed. Brain MRI (picture 1) revealed T2 hyperintensity at left lower pons, bilateral medulla, and cervical spinal cord. Due to pre-medullary tortuous flow void seen, dural arteriovenous fistula was suspected. Angiography of carotid artery then confirmed an indirect CC fistula fed mainly by internal maxillary artery, draining to anterior spinal vein. (picture 2) ● After transvenous coiling of CC fistula, limb weakness and diplopia improved gradually within days. Serial MRI showed complete remission of spinal cord edema and partial regression of brainstem edema (picture 3).
Clinical presentation of dural arteriovenous fistula (dAVF) depends in large part on the venous drainage route and available collaterals. Herein we reported a case of brainstem dysfunction secondary to dAVF, specifically, carotid-cavernous fistula (CC fistula), with remission of brainstem edema after transvenous coiling, This case reminded us that dAVF should be included in the differential diagnosis of brainstem edema. Also, timely recognition and treatment may reverse the venous congestion-related dysfunction.