Dural fistula with bilateral arterial supply, mimicking a brainstem tumor

Liaffa, Bárbara; Noro, Fábio; Bahia, Paulo Roberto Valle; Motta, Flávia Pinto Dezonne; Marchiori, Edson

doi:10.1590/0100-3984.2015.0186

Cited by 2 publications

(1 citation statement)

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“…Dural arteriovenous fistulas (DAVFs) are abnormal connections between small arterial and venous systems without intervening capillary beds 1 . Intracranial DAVF is rare, and is estimated to account for less than 10% of cerebral vascular malformations 2 Herein, we present a rare case of intracranial DAVF with perimedullary drainage that presented as recurrent Fig.…”

Section: Introductionmentioning

confidence: 99%

An Isolated Unilateral Pontomedullary Lesion Due to An Intracranial Dural Arteriovenous Fistula Mimicking A Brain Tumor - Case and Review

2019

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Intracranial dural arteriovenous fistula (DAVF) with perimedullary venous drainage may cause brainstem swelling and represent a diagnostic challenge.A 66-year-old man presented to the emergency room with recurrent vertigo, minimal truncal ataxia with a wide-based gait, and a slightly impaired tandem gait. Brain magnetic resonance imaging (MRI) revealed a hyperintense lesion in the left pontomedullary area on T2-weighted images (T2WIs) with partial gadolinium enhancement, but without increased signals on diffusion-weighted images. Abnormal serpentine flow void vessels surrounding the medulla and upper cervical spinal cord were initially overlooked but discovered later. An angiogram revealed DAVF with feeders from the right occipital artery and the meningeal branch of the right distal vertebral artery with drainage into the anterior medullary venous system and the perimedullary veins. The patient underwent a successful transarterial endovascular embolization and improved gradually. A brain MRI at 3-month follow-up revealed a residual hyperintense signal on the T2WIs in the left lower medulla. Six cases of patients exhibiting DAVF with isolated unilateral brainstem swelling from the literature were reviewed. Isolated unilateral brainstem swelling due to intracranial DAVF with perimedullary venous drainage is extremely rare and might mimic a tumor on MRI. Abnormal serpentine flow void vessels on the surface of the brainstem or spinal cord are crucial diagnostic clues. (J Nippon Med Sch 2019; 86: 48 54)

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Section: Introductionmentioning

confidence: 99%