Two Cases of a Dural Arteriovenous Fistula Mimicking a Brain Tumor

Abstract

<jats:p> Dural arteriovenous fistula (d-AVF) is relatively rare. Some cases of atypical locations are often difficult to distinguish from other vascular disorders or tumors because those d-AVFs show various onsets, such as subcortical bleeding and venous infarctions. We encountered two cases of d-AVF with severe brain edema that took adequate time to distinguish from brain tumors. A 68-year-old man visited his local physician complaining of dizziness. He was diagnosed with a cerebral infarction due to the presence of an abnormal cerebellar signal on magnetic resonance imaging (MRI) and was treated by drip infusion. However, he did not recover and was admitted to our hospital with suspicion of a brain tumor. A 75-year-old woman with an onset of progressive dementia and gait disturbance showed severe edema of the right-front temporal lobe on MRI. Both these cases were examined by single photon emission computed tomography or positron emission tomography and were scheduled for craniotomy and biopsy based on the diagnosis of brain tumor. We performed pre-operative angiography and found d-AVFs. We embolized the d-AVFs with liquid material and both patients recovered well. </jats:p><jats:p> Brain edema from d-AVF or a tumor can be distinguished by carefully reading the MRI with findings such as the distribution of the edemas, differences on diffusion-weighted images, and contrast-enhanced images. Therefore, it is important to provide initial accurate diagnoses to prevent patient mistrust and irreversible disease conditions. </jats:p>

CT and MR imaging of non-cavernous cranial dural arteriovenous fistulas: Findings associated with cortical venous reflux

“…In our series, this was sometimes shown to be associated with enhancement and the combination of both findings could potentially mimic intra-axial neoplasms, similar to a prior case report [18]. However, similar to the observation from Kwon et al [5], these non-specific parenchymal findings were always associated with abnormally dilated and tortuous leptomeningeal and/or medullary vessels.…”

A Case of Dural Arteriovenous Fistula Mimicking a Cerebellar Tumor

“…The natural history of DAVF is unpredictable, and due to variable clinical presentations (from asymptomatic to intracranial hemorrhage) and neuroimaging features, the diagnosis of DAVF is often delayed or missed. 1 -3 In this case, the DAVF mimicked a cerebellar tumor. Clinicians should be aware of and suspect this condition in patients with progressive focal neurological symptoms and atypical mass lesions, especially if there is a suggestion of abnormal vasculature on postcontrast images or because of the presence of flow voids.…”

Dural arteriovenous fistulas misdiagnosed as intracranial neoplasms: illustrative case

“…A recent study 26 found a 3% recurrence rate of dAVF initially occluded by endovascular treatment, which should be kept in mind. In our review 3 cases needed retreatment for incomplete obliteration, 1 was due to persistent imaging findings 23 and 1 was due to recurrence of symptoms, 17 whereas technical difficulties caused multiple treatments in the third.…”

“…A dAVF initially misdiagnosed as a neoplastic pathology is rare, with the majority of cases accounting for brainstem lesions. Only three cases of diencephalic, [19][20][21] two cerebellar 22,23 and two supratentorial lesions 23,24 have been reported. Table 1 provides the results of our literature review.…”