Dural arteriovenous fistula presenting as reversible dementia
DOI:
https://doi.org/10.18203/2349-3933.ijam20214879Keywords:
Dural AV fistula, Reversible dementia, EmbolisationAbstract
DAVF is an abnormal connection between arteries and veins, where supply is mainly through branches arising from the external carotid artery. A 30 years old male had multiple episodes of seizures and progressive behavioral and cognitive decline, inattention and disorientation to time, place and person, along with ptosis and ophthalmoplegia in the right eye. DSA provided a definitive diagnosis of hypervascular Dural AV fistula at the right transverse sigmoid junction with significant cortical venous hypertension. Through femoral access, both underwent transarterial embolization through the Middle Meningeal branch of the right external carotid artery using onyx, resulting in complete occlusion of fistula and resolution of venous hypertension. Post embolisation, cognitive function assessment revealed increased attention span and improved orientation with time, place and person. Thus, DAVF can be one of the rare but reversible causes of dementia. Early diagnosis and treatment may help to dramatically improve patients’ clinical condition and minimize long-term disability.
References
Tripathi M, Vibha D. Reversible dementias. Indian J Psychiatry. 2009;51(l1):52-5.
Henderson JB, Zarghouni M, Hise JH, Opatowsky MJ, Layton KF. Dementia caused by dural arteriovenous fistulas reversed following endovascular therapy. Proc. 2012;25(4):338-40.
Ma C, Lu Q, Shi W, Su Z, Zhao Y, Li C, et al. Diagnosis and treatment of a dural arteriovenous fistula presenting with progressive parkinsonism and dementia: A case report and literature review. Exp Ther Med. 2015;9(2):523-6.
Zipfel GJ, Shah MN, Refai D, Dacey RG, Derdeyn CP. Cranial dural arteriovenous fistulas: modification of angiographic classification scales based on new natural history data. Neurosurg Focus. 2009;26(5):14.
Gandhi D, Chen J, Pearl M, Huang J, Gemmete JJ, Kathuria S. Intracranial dural arteriovenous fistulas: classification, imaging findings, and treatment. AJNR Am J Neuroradiol. 2012;33(6):1007-13.
Chahbazian K, Théaudin M, Lehmann P, Sachet M, Adams D, Saliou G. Reversible pseudo-Creutzfeldt-Jakob syndrome related to cerebral dural arteriovenous fistula. J Am Geriatr Soc. 2014;62(10):2024-6.
Hurst RW, Bagley LJ, Galetta S, Glosser G, Lieberman AP, Trojanowski J, et al. Dementia resulting from dural arteriovenous fistulas: the pathologic findings of venous hypertensive encephalopathy. AJNR Am J Neuroradiol. 1998;19(7):1267-73.
Brito A, Tsang ACO, Hilditch C, Nicholson P, Krings T, Brinjikji W. Intracranial Dural Arteriovenous Fistula as a Reversible Cause of Dementia: Case Series and Literature Review. World Neurosurg. 2019;121:543-53.
Nakahara Y, Ogata A, Takase Y, Maeda K, Okamoto H, Matsushima T, et al. Treatment of dural arteriovenous fistula presenting as typical symptoms of hydrocephalus caused by venous congestion: case report. Neurol Med Chir. 2011;51(3):229-32.
Halbach VV, Higashida RT, Hieshima GB, Mehringer CM, Hardin CW. Transvenous embolization of dural fistulas involving the transverse and sigmoid sinuses. AJNR Am J Neuroradiol. 1989;10(2):385-92.
Barnwell SL, Halbach VV, Higashida RT, Hieshima G, Wilson CB. Complex dural arteriovenous fistulas. Results of combined endovascular and neurosurgical treatment in 16 patients. J Neurosurg. 1989;71(3):352-8.
