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Dural arteriovenous fistulae causing pseudotumour cerebri syndrome in an elderly man
P Silberstein1, P Kottos, C Worner
1Department of Neurology, St. George Hospital, Gray Street, NSW 2217, Kogarah, Australia.
Insights
Dural arteriovenous fistulae (DAVF) can cause intracranial hypertension, particularly when venous drainage is abnormal. This case highlights pseudotumor cerebri syndrome in an elderly patient with bilateral DAVF.
Area of Science:
- Neurology
- Vascular Neurology
- Neuroimaging
Background:
- Dural arteriovenous fistulae (DAVF) are abnormal connections between dural arteries and veins.
- Clinical presentation varies based on fistula location and venous drainage patterns.
- Intracranial hypertension is an uncommon but serious complication of DAVF.
Observation:
- A case of pseudotumor cerebri syndrome in an elderly male is presented.
- The patient had bilateral intracranial DAVF.
- The fistulae were supplied by the occipital arteries.
Findings:
- Cerebral angiography confirmed the diagnosis and characterized abnormal venous drainage.
- The specific venous drainage pattern was crucial in the development of intracranial hypertension.
- This case illustrates a rare presentation of DAVF in the elderly.
Implications:
- Understanding venous drainage is critical for predicting DAVF complications like intracranial hypertension.
- DAVF should be considered in elderly patients presenting with pseudotumor cerebri syndrome.
- Accurate diagnosis and characterization of DAVF via angiography are essential for management.
Abstract:
The clinical presentation of dural arteriovenous fistulae (DAVF) is dependent on their location and the nature of their venous drainage. The latter plays a critical part in determining whether or not the fistula gives rise to intracranial hypertension, which is present in only a minority of cases. We present a case of the pseudotumour cerebri syndrome in an elderly man with bilateral intracranial DAVF supplied by the occipital arteries. Cerebral angiography was required for definitive diagnosis, and to characterise the abnormal venous drainage. The pathophysiology of intracranial hypertension in DAVF is discussed.