Dural arteriovenous fistula discovered in patient presenting with recent head trauma

Abstract

PatientMale, 32Final Diagnosis: Dural arterio-venous fistulaSymptoms: Eye redness • post-trauma headache • tinnitusMedication: —Clinical Procedure: Fistula embolizationSpecialty: NeurologyObjective:Mistake in diagnosisBackground:A dural arteriovenous fistula (DAVF), is an abnormal direct connection (fistula) between a meningeal artery and a meningeal vein or dural venous sinus. The pathogenesis of DAVF still remains unclear. Sinus thrombosis, head trauma, chronic central nervous system, hypercoagulable state, surgery, and hormonal influence are the pre-disposing factors that initiate this disease. The symptoms experienced by the patient will depend on the location of the fistula.Case Report:Thirty-two year old Hispanic male who presented one day after a rear ended motor vehicle collision (MVC) with a severe throbbing headache in the left parietal region, left eye redness but no retro-orbital pain and tinnitus in the left ear. He was initially misdiagnosed to have a carotid-cavernous fistula but upon cerebral angiogram was actually diagnosed with a dural arterio-venous fistula in the posterior fossa venous system followed by successful embolization of the fistula.Conclusions:A cerebral angiography is the gold standard for detection and characterization of a DAVF and will distinguish it from a CCF. Endovascular surgery involves a catheter-based technique for embolization of the lumen of arteries feeding the DAVF, or directly into the vein draining the DAVF. It is very important to recognize the typical findings of patients presenting with a DAVF then quickly proceeding with a cerebral angiogram to determine the exact location of the fistula and the appropriate treatment plan. By diagnosing and treating a DAVF as early as possible, the associated fatal complications can be averted.

Are type I dural arteriovenous fistulas safe? Single-centre experience of endovascular treatment of dural arteriovenous fistulas

“…Post-traumatic dural arteriovenous fistulas represent a small proportion of all dural fistulas in scientific reports, mostly cases with no (to the best of our knowledge) cohort studies [12-14]. The majority of all reported cases of head trauma-related dAVFs are caroticocavernous fistulas, which have a distinct presentation and natural history [15].…”

“…Overall in our study group five patients had a history of head trauma, complicated by intracranial haemorrhage or tuberculous meningitis, all of which are risk factors for development of dAVFs. Most of these can be attributed to either vascular wall incompetency (posttraumatic or other) or hypercoagulable (even if local, and immune driven) states [4,10-12].…”

Increasing awareness with recognition of pulsatile tinnitus for nurse practitioners in the primary care setting

“…The underlying development of AVF/DAVF may be unclear, but there are known predisposing factors. Hypercoagulable states, tumors, trauma such as with a motor vehicle accident, and sinus thrombosis can initiate this disease (Cooper et al, 2013). Surgery is another factor that can cause an AVF, such as the cervical discectomy that S. P. underwent.…”

Endovascular coil embolization of aneurysm neck for the treatment of ruptured intracranial aneurysm with bleb formation

“…This vascular malformation is very likely to rupture in up to 50% of patients [1], and only a few risk factors for rupture has been identified so far [2,3]. Ruptured ICA results in a number of cerebrovascular complications associated with high morbidity [4–6], leading to a high mortality rate [7–9].…”

“…Intracranial aneurysms (ICA) are localized, pathological dilation or ballooning of a cerebral artery, with an incidence of 2–5% in the general population [ 1 ]. This vascular malformation is very likely to rupture in up to 50% of patients [ 1 ], and only a few risk factors for rupture has been identified so far [ 2 , 3 ]. Ruptured ICA results in a number of cerebrovascular complications associated with high morbidity [ 4 – 6 ], leading to a high mortality rate [ 7 – 9 ].…”