Intracranial Hemorrhage from Dural Arteriovenous Fistulas: What Can We Find with CT Angiography?

Abstract

(1) Background: Dural arteriovenous fistulas (DAVF) represent a rare acquired intracranial vascular malformation, with a variety of clinical signs and symptoms, which make their diagnosis difficult. Intracranial hemorrhage is one of the most serious clinical manifestations. In this paper the authors’ goal was to verify the accuracy and utility of contrast-enhanced brain CT angiography (CTA) for the identification and the characterization of dural arteriovenous fistulas (DAVFs) in patients who presented with brain hemorrhage compared to 3D digital subtraction angiography (3D DSA); (2) a retrospective study of 26 patients with DAVFs who presented with intracranial hemorrhage to our institution was performed. The information reviewed included clinical presentation, location and size of hemorrhage, brain CTA and 3D DSA findings; (3) results: 61% (16/26) of DAVFs were identified by CTA. The vast majority of patients were male (69%, 18/26) and the most common presenting symptom was sudden onset headache. All DAVFs had cortical venous drainage and about one-third were associated with a venous varix. The most common location was tentorial (73%, 19/26); (4) conclusions: CTA can represent a valid alternative diagnostic method to 3D DSA for the study of DAVF in the initial and preliminary diagnostic approach, especially in emergency situations. In fact, it represents a fast, inexpensive, non-invasive and above all, easily accessible and available diagnostic technique, unlike DSA or MRI, allowing to provide information necessary for the identification, classification and treatment planning of DAVFs.

Uncommon Causes of Nontraumatic Intracerebral Hemorrhage

“…Dural arteriovenous fistula can present with ICH, with a predominance in males in the sixth decade. 41 In the context of ICH, certain imaging signs might suggest the presence of a dural arteriovenous fistula. These are characterized by asymmetrical or dilated dural arteries, multiple enlarged cortical veins, and distinct sinus-related indicators.…”

Imaging in Non-Traumatic Emergencies

“…“Intracranial Hemorrhage from Dural Arteriovenous Fistulas: What Can We Find with CT Angiography?” by A. Negro et al [ 24 ] discusses a relatively rare acquired intracranial vascular malformation that presents with a variety of clinical signs and symptoms, which sometimes makes diagnosis very difficult. In this paper, the authors’ goal was to verify the accuracy and utility of contrast-enhanced brain CT angiography (CTA) for the identification and characterization of dural arteriovenous fistulas (DAVFs) in patients who presented with brain hemorrhage compared to 3D digital subtraction angiography (3D DSA) and MRI.…”

Direct Burr Hole Access for Transverse–Sigmoid Junction DAVF Embolization: A Case Report

“…Intracranial venous drainage can be disrupted depending on the location of the fistula. A meta-analysis of 377 patients found that DAVFs associated with aggressive neurological behaviors were more likely located at the tentorial incisure; aggressive presentations were most often related to hemorrhagic or non-hemorrhagic stroke [ 1 , 4 ]. This same study demonstrated that DAVFs least likely to present with aggressive neurological behaviors were located at the transverse–sigmoid sinuses and cavernous sinuses [ 5 ].…”

“…Intracranial hemorrhage is one of the most serious clinical manifestations of DAVFs and can lead to severe neurological deficits and death [ 2 , 3 ]. The incidence of hemorrhage in patients with DAVFs is 7–33% [ 2 , 4 , 6 ]. The prognosis for patients presenting with intracranial hemorrhage is poor, with mortality ranging from 20% to 30% [ 1 ].…”