Dural arteriovenous fistula with venous hypertension

Widespread enlargement of the cortical veins in both cerebral hemispheres and posterior fossa, best appreciated on the SWI MIP images.

Assymetery Additionally, there is marked enlargement of the transverse sinusesexternal carotid artery branches, larger on the right.

Serpinginous branchesparticularly of the scalp and meninges. 

Large right anterior cerebral artery which appear to drain into the anterior aspect of the sagittaltransverse sinus close to the vertex, outwardly convex suggesting high flow. Hypoplastic left transverse sinus.

ModerateThe brain appears swollen with patchy high T2 signal. There is, in addition, tonsilar descent and a moderate amount of periventricular high T2 signal without. The lateral ventricular bodies are broad probably due to a non-visualised cavum septum pellucidum or maybe an absent septum (in either case, this is incidental). 

No diffusion restriction.

Cerebral angiogram performed - images not available.

Cerebral Angiography Report

Under local anesthesia through right femoral approach cerebral angiogram was done after selective cannulation of right and left carotid and right and left vertebral arteries. Selective cannulation of internal and external carotid arteries performed.

This study shows type D dural fistula in the superior sagittal sinus at the vertex being supplied by meningeal and superficial arteries on both sides, parietal branches of the ACA and ophthalmic via the palpebral branches of upper eye lid.

There is another fistula at the torcula with main feeders from the right occipital artery. There are multiple dilated cortical venous radicals with venous ectasia in the brain draining via cavernous sinuses. The circulation time is prolonged to 14.0 seconds with early filling of the sagittal sinus via fistula.

CommentConclusion: Dural fistuladural arteriovenous fistulas (dAVF)