Intracranial dural AV fistula- An unfolding enigma


Case Report

Author Details : Rajesh Shenoy, Ravi Ichalakaranji, Prakash Mahantshetti

Volume : 4, Issue : 3, Year : 2018

Article Page : 155-159

https://doi.org/10.18231/2455-8451.2018.0037



Suggest article by email

Get Permission

Abstract

 An Intracranial dural arteriovenous fistulas (DAVF), is an abnormal direct connection (fistula) between a meningeal artery and a meningeal vein or dural venous sinus &/ cortical vein 1. When there are multiple fistulas they are termed as dural arteriovenous malformations and comprise 10-15% of all intracranial arteriovenous malformations1.
Here we present a case of
52yr old patient who presented to our casualty with history of sudden onset of
headache, giddiness, and vomiting, followed by loss of consciousness. Neurological examination revealed impairment of consciousness, no verbal response, with left hemiparesis (E2V1M5). Bilaterally, pupils were 5mm and sluggishly reacting to light. Vitals were stable with B.P. recording of 140/80 mm of hg, and a pulse rate of 80 /min. Pre contrast CT scan showed an intraparenchymal haemorrhage with perilesional oedema in the right frontal region.
CT angiography brain
showeda intracranial dural AVF with varix and adjacent intraparenchymal haemorrhage.
D.S.A. revealed a Borden type III & Cognard type IV –midline dural Arteriovenous fistula in the region
ofmid superior sagittal sinus and along the cerebral falx, with a large venous ectasia/varix along the anterior cerebral falx.
Management: Patient underwent a
fronto parietal rectangular craniotomy Right posterior frontal, parasagittal engorged bunch of focal cortical veins was cauterized. Underlying haematoma was evacuated and the underlying venous ectasia/ varix identified. It was found to be thrombosed. A large draining vein was found which was clipped and any consequent brain swelling was looked for, before finally excising it in toto.
Post –op period was uneventful, with the patient gradually improving in sensorium with residual hemiplegia and aphasia.
Although recent developments in catheter intervention
has made it the preferred option in most of the cases, surgery is still preferred in some select cases.

Keywords:Intracranial dural AV fistula, Superior sagittal sinus, Cognard and
borden classification, CT andiography
, Digital subtraction angiography 


How to cite : Shenoy R, Ichalakaranji R, Mahantshetti P, Intracranial dural AV fistula- An unfolding enigma. IP Indian J Neurosci 2018;4(3):155-159


This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.







View Article

PDF File  


Copyright permission

Get article permission for commercial use

Downlaod

PDF File    


Digital Object Identifier (DOI)

Article DOI

https://doi.org/ 10.18231/2455-8451.2018.0037


Article Metrics






Article Access statistics

Viewed: 1572

PDF Downloaded: 636