Dural arteriovenous fistula (dAVF) - progression from normal to marked

Case contributed by A.Prof Frank Gaillard

Presentation

Presents with a headache and left-sided pulsatile tinnitus.

Patient Data

Age: 35 years

Multiple filling defects are present in the left transverse sinus, sigmoid sinus and jugular bulb consistent with prior dural venous sinus thrombosis. No convincingly abnormal vessels. Normal brain parenchyma. 

2 years later an obvious dural arteriovenous fistula is evident with prominent external carotid supply via numerous scalp vessels. Prominent central venous drainage with a venous varicosity in the left cerebellopontine angle. 

A further MRI 5 years post presentation, and 2 years after attempted left-sided onyx embolization, the size of the dAVF has increased further with massive widespread vessels. In the right frontal lobe edema surrounds a transparenchymal draining vein with a focal stenosis or thrombosis seen laterally. 

Case Discussion

This case is interesting not only because of the dramatic progression from normal (other than sinus thrombosis) to grossly abnormal, but also because it is a reminder that MRI is insensitive to small/early vascular malformations. In such cases, one should have a low threshold for catheter angiography that can identify very subtle arteriovenous shunting. This is, in fact, what occurred in this case, with the diagnosis of a dural arteriovenous fistula (dAVF) made after the first study. 

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Case information

rID: 55410
Published: 16th Jun 2018
Last edited: 16th Jun 2018
Inclusion in quiz mode: Included

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