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A cerebrovascular accident with unusual features
Stroke
|September 1, 1983
Summary
A patient experienced transient ischemic attacks (TIAs) and later developed a frontal hematoma. A dural arteriovenous fistula was discovered and successfully treated.
Area of Science:
- Neurology
- Neurosurgery
- Vascular Neurology
Background:
- Transient ischemic attacks (TIAs) can be indicative of underlying vascular abnormalities.
- Dural arteriovenous fistulas (dAVFs) are abnormal connections between dura mater arteries and venous sinuses or cortical veins.
Observation:
- A 64-year-old male presented with recurrent TIAs and headache over two weeks.
- Initial CT scans revealed unusual enhancement near the superior sagittal sinus.
- A left frontal hematoma developed 27 months later, presenting with laconism, abulia, and whispering.
Findings:
- Cerebral angiography identified a dural arteriovenous fistula in the left hemisphere.
- The fistula drained into cortical veins, suggesting a potential cause for the TIA-like episodes and hematoma.
Implications:
- This case highlights the importance of investigating TIA-like symptoms, even if initially inconclusive.
- Delayed presentation of dural arteriovenous fistulas can lead to significant neurological deficits, including intracranial hemorrhage.
- Surgical intervention for dural arteriovenous fistulas can be effective in resolving symptoms and preventing further complications.