Dural-Pial Arteriovenous Malformation After Sinus Thrombosis

Abstract

Background-We report an unusual case of acquired dural-pial arteriovenous malformation (AVM) following sinus thrombosis. Case Description-Initial angiography performed in a 39-year-old man showed thrombosis of the superior sagittal sinus (SSS) and the right transverse sinus (TS) but no vascular malformations. Follow-up angiography 29 months later revealed recanalization of the SSS and the TS, retrograde cortical venous drainage which suggested that thrombosis of the sinuses probably propagated into the adjacent parietal cortical veins, and development of a dural-pial AVM at or near the site of thrombi in more than one cortical vein. Complete surgical excision of the lesion was accomplished without neurological deterioration. Conclusions-The present case suggests the possibility that the pial AVM is not only a congenital condition but also may develop as an acquired lesion. (Stroke. 1998;29:1721-1724.)Key Words: angiogenesis Ⅲ cerebral arteriovenous malformations Ⅲ sinus thrombosis D ural arteriovenous malformations (AVMs) appear to be acquired rather than congenital lesions, and it is well known that they often develop at the site of a sinus thrombosis. 1,2,3,4 On the other, hand, pial AVMs are generally considered to be congenital malformations. We report a case of acquired dural-pial AVM following superior sagittal and transverse sinus thrombosis and discuss the causes both of the unusual location of the dural AVM and of the development of the pial lesion in this case. Case ReportThe patient was a 39-year-old man who, on July 27, 1994, experienced headache and vomiting, followed 2 days later by weakness in the upper part of his left arm. He was hospitalized 4 days later, and neurological examinations indicated left hemiparesis.CT scan revealed a low-density area with a mass effect in the right frontal lobe (Figure 1), and on enhanced CT an empty delta sign was observed in the superior sagittal sinus (SSS). MRI showed sinus thrombosis of the SSS and the right transverse sinus (TS). However, MRI revealed no abnormal findings suggestive of a vascular malformation. Because no image of the anterior half of the SSS or the right TS could be detected in angiograms of the right common carotid artery, a diagnosis of sinus thrombosis of the SSS and the right TS was made (Figure 2A and 2B). Nevertheless, no dural or pial AVMs were found ( Figure 2C and 2D).Immediately after admission, anticoagulant therapy was initiated. Both the headache and the left hemiparesis improved gradually and since, there were no clearly abnormal findings on neurological examination other than a slight exaggeration of the deep tendon reflex on the left side, the patient was discharged. Although MRI performed on September 27, 1996, revealed recanalization of the SSS and the right TS, at the same time a large number of flow void signals Figure 3A and 3B). It was also noted that the SSS was patent but there was a reflux of blood into the cortical veins, and the venous routes between the cortical veins and the SSS were occluded ( Figure 3C). Meanwh...

Mixed pial-dural fistula development after ventricular shunting

“…This case supports the theory that some cranial fistulae are acquired1 and can rarely be mixed pial-dural 2. Dural AVFs cause venous hypertension and ischaemia, which may directly elevate vascular endothelial growth factor (VEGF),3 or indirectly through decreased cerebral perfusion pressure 4 5.…”

Development of multiple cerebral arteriovenous malformations documented in an adult by serial angiography

“…Typically, dural AVMs are acquired lesions, occurring as a result of trauma, surgical procedures, or sinus thrombosis. 6,7,9,11 In contrast, cerebral AVMs (pial AVMs) are considered to be congenital lesions. During the second to fifth stage of Streeter craniocerebral vascularization, the primitive vascular plexus within the embryonic brain differentiates into arterial, capillary, and venous components.…”

Acquired Pial Arteriovenous Fistula Following Cerebral Vein Thrombosis

“…20,21 Venous hypertension may foster the growth of microscopic arteriovenous shunts found within the vasa vasorum of the normal pachymeninges and/or may stimulate the release of angiogenic factors. [22][23][24][25] Ozawa et al 26 recently reported a case of a pial arteriovenous malformation with dural supply occurring after an episode of dural sinus thrombosis. In their case, dural sinus thrombosis resulted in a remote, pial arteriovenous malformation with meningeal arterial supply.…”