Dural arteriovenous malformations and intracranial hemorrhage

Malik, Ghaus M.; Pearce, Joanne; Ausman, James I.; Mehta, Bharat

doi:10.1097/00006123-198409000-00007

Cited by 28 publications

(39 citation statements)

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“…Most are idiopathic, though some can be related to prior surgery, trauma, or dural sinus thrombosis. [8][9][10]17,30,44,47,55,64,71,80 Modes of presentation include 1) intracranial hemorrhage (ICH) due to cortical venous hypertension, 2) nonhemorrhagic neurological deficits (NHNDs) due to cortical venous hypertension, 3) symptoms of increased sinus drainage including pulsatile tinnitus and ophthalmological phenomenon, and 4) incidental. 6,7,10 The natural history of dAVFs is strongly linked to the absence or presence of drainage into cortical veins, which is termed cortical venous drainage (CVD).…”

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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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confidence: 99%

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

Holekamp

Mollman

Murphy

et al. 2016

JNS

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“…Subsequently, more detailed studies have demonstrated that after accounting for the pattern of venous drainage, location has no direct correlation with the behavior or natural history of a particular lesion [106,107,134]. Instead, due to local venous anatomy, DAVMs in some locations (such as the ACF and tentorial incisura) are more likely to develop retrograde parenchymal venous drainage; it is this pattern of venous drainage that has been demonstrated to be predictive of aggressive behavior [106,107,[159][160][161].…”

Section: Prognosismentioning

confidence: 99%

Central Nervous System Vascular Malformations

Davidson¹,

Stoodley²

2012

Congenital Anomalies - Case Studies and Mechanisms

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“…These DAVFs represent 6% of supratentorial and 35% of infratentorial vascular malformations. 40 Since their original angiographic description by Sachs in 1931, 43 numerous studies have been published describing DAVF angiographic features, 3,10,15,43 mode of presentation, 1,3,10,13,15,19,28,36,43 and subsequent clinical course. 5,13,16,45,46,48 From these studies, several important clinical characteristics have been discerned.…”

Section: Neurosurg Focus 26 (5):e14 2009mentioning

confidence: 99%

“…22,23,27,32,34,35,39,46,48,49 Third, the natural history of DAVFs depends greatly on the presence or absence of CVD. Although the association between CVD and presentation with symptoms of ICH or NHND has long been appreciated, 1,3,6,11,13,15,16,25,36,48 only in the past decade has it become clear that CVD also increases the risk of subsequent neurological events. 16,48 Appropriately, the importance of CVD has been reflected in the angiographic classification systems of Borden and This article presents a modification to the existing classification scales of intracranial dural arteriovenous fistulas based on newly published research regarding the relationship of clinical symptoms and outcome.…”

Section: Neurosurg Focus 26 (5):e14 2009mentioning

confidence: 99%

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Cranial dural arteriovenous fistulas: modification of angiographic classification scales based on new natural history data

Zipfel

Shah²,

Refai³

et al. 2009

FOC

179

122

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This article presents a modification to the existing classification scales of intracranial dural arteriovenous fistulas based on newly published research regarding the relationship of clinical symptoms and outcome. The 2 commonly used scales, the Borden-Shucart and Cognard scales, rely entirely on angiographic features for categorization. The most critical anatomical feature is the identification of cortical venous drainage (CVD; Borden-Shucart Types II and III and Cognard Types IIb, IIa + b, III, IV, and V), as this feature identifies lesions at high risk for future hemorrhage or ischemic neurological injury. Yet recent data has emerged indicating that within these high-risk groups, most of the risk for future injury is in the subgroup presenting with intracerebral hemorrhage or nonhemorrhagic neurological deficits. The authors have defined this subgroup as symptomatic CVD. Patients who present incidentally or with symptoms of pulsatile tinnitus or ophthalmological phenomena have a less aggressive clinical course. The authors have defined this subgroup as asymptomatic CVD. Based on recent data the annual rate of intracerebral hemorrhage is 7.4–7.6% for patients with symptomatic CVD compared with 1.4–1.5% for those with asymptomatic CVD. The addition of asymptomatic CVD or symptomatic CVD as modifiers to the Borden-Shucart and Cognard systems improves their accuracy for risk stratification of patients with high-grade dural arteriovenous fistulas.

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Dural arteriovenous malformations and intracranial hemorrhage

Cited by 28 publications

References 0 publications

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

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

Central Nervous System Vascular Malformations

Cranial dural arteriovenous fistulas: modification of angiographic classification scales based on new natural history data

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