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Severe papilledema and multiple hypercoagulability abnormalities in patient with dural arterio-venous fistulas

Chi-Wei Tien1, Patrick Nicholson2, Edward Margolin3,4

  • 1Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.

Interventional Neuroradiology : Journal of Peritherapeutic Neuroradiology, Surgical Procedures and Related Neurosciences
|May 5, 2022
PubMed

Insights

Brain dural arteriovenous fistulas (bdAVF) can cause vision loss due to increased intracranial pressure. Early neuro-ophthalmological evaluation and hypercoagulable testing are crucial for managing bdAVF patients.

Area of Science:

  • Neurology
  • Ophthalmology
  • Vascular Surgery

Background:

  • Brain dural arteriovenous fistulas (bdAVF) are abnormal connections between dura mater arteries and veins.
  • These fistulas can lead to venous hypertension and increased intracranial pressure.

Observation:

  • A 54-year-old man presented with pulsatile tinnitus and transient visual obscurations.
  • MRI revealed two brain dural arteriovenous fistulas in the sagittal and right sigmoid dural sinuses.
  • Neuro-ophthalmological examination showed severe bilateral optic disc edema and early visual field defects.

Findings:

  • Hypercoagulable testing revealed elevated D-dimer, decreased protein S, and elevated homocysteine levels.
  • The patient's symptoms were attributed to venous hypertension secondary to bdAVFs, causing papilledema.
  • Papilledema, if untreated, can lead to irreversible visual loss.

Implications:

  • Routine neuro-ophthalmological consultation is essential for all patients with bdAVFs to detect and manage papilledema.
  • Early screening for visual field defects is critical to prevent irreversible vision loss.
  • Comprehensive hypercoagulable workup in bdAVF patients is vital for preventing thromboembolic events.
Keywords:
dural arteriovenous fistulahypercoagulationpapilledema

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