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Frontal intermittent rhythmic delta activity (FIRDA) in pial-dural arteriovenous malformation
S M Nazarian1, R E Potts, M Z Chesser
1Neurology Service, John L. McClellan Memorial Veterans Hospital, Little Rock, Arkansas 72205.
Abstract:
We report a case of FIRDA associated with a pial-dural arteriovenous malformation (AVM). The patient presented with headaches, papilledema and partial oculomotor nerve palsy. CT scan had failed to discover the AVM. After partial embolization of the AVM, the patient's symptoms and signs resolved, and the FIRDA disappeared. FIRDA has been thought to be caused by frontal lobe ischemia or periventricular edema. It has not been reported in benign intracranial hypertension (BIH). We postulate that the FIRDA in this case was due to the circulatory "steal" effect of the AVM, and not to the intracranial hypertension. Five percent of patients with dural AVM's present with a picture consistent with BIH. We recommend a diligent search for additional pathology if FIRDA is seen in association with presumed BIH.
Insights
Frontal intermittent rhythmic delta activity (FIRDA) can be linked to pial-dural arteriovenous malformations (AVMs). This case suggests AVMs, not just intracranial hypertension, may cause FIRDA, highlighting the need for thorough AVM investigation.
Area of Science:
- Neurology
- Neuroimaging
- Vascular Neurology
Background:
- Frontal intermittent rhythmic delta activity (FIRDA) is typically associated with frontal lobe ischemia or periventricular edema.
- FIRDA has not been previously reported in association with benign intracranial hypertension (BIH).
Observation:
- A patient presented with headaches, papilledema, and partial oculomotor nerve palsy.
- Computed tomography (CT) scans failed to identify an underlying pial-dural arteriovenous malformation (AVM).
- The patient exhibited FIRDA, which was initially considered in the context of presumed BIH.
Findings:
- A pial-dural arteriovenous malformation (AVM) was identified as the cause of the patient's symptoms.
- Partial embolization of the AVM led to the resolution of headaches, papilledema, and oculomotor nerve palsy.
- Following AVM treatment, the FIRDA disappeared, supporting a causal link.
Implications:
- This case suggests that circulatory "steal" effect from AVMs, rather than intracranial hypertension, may cause FIRDA.
- It is recommended to diligently search for additional pathology, such as AVMs, when FIRDA is observed in patients with presumed BIH.
- This finding expands the differential diagnosis for FIRDA and emphasizes the importance of comprehensive vascular evaluation.