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Dural arteriovenous malformation with symmetrical calcification of the basal ganglia: a case report
1Department of Pediatrics, Taichung Veterans General Hospital, Taiwan, R.O.C.
Insights
This case report details a rare pediatric dural arteriovenous malformation presenting with status epilepticus and basal ganglia calcification. Surgical intervention led to seizure freedom and neurological improvement.
Area of Science:
- Pediatric Neurology
- Neuroradiology
- Vascular Neurosurgery
Background:
- Dural arteriovenous malformations (dAVFs) are uncommon in children, especially when associated with basal ganglia calcification.
- This report focuses on a rare pediatric case presenting with acute neurological deficits.
Observation:
- A 22-month-old infant experienced acute onset of status epilepticus, hemiparesis, and neurological signs.
- Physical examination revealed a heart murmur and engorged scalp veins.
- Brain imaging demonstrated cortical atrophy, symmetrical basal ganglia calcification, and a right parietal vascular malformation.
Findings:
- Cerebral angiography confirmed a dural arteriovenous malformation with specific arterial feeders and venous drainage into the superior sagittal sinus.
- The malformation was characterized by a signal-voided tortuous structure on MRI.
- Computed tomography revealed symmetrical calcification of the basal ganglia.
Implications:
- Surgical ligation of feeding arteries successfully treated the dural arteriovenous malformation.
- The patient achieved seizure cessation and gradual recovery of neurological deficits.
- This case highlights the importance of considering dAVFs in pediatric patients with unexplained neurological symptoms and basal ganglia calcification.
Abstract:
Dural arteriovenous malformations associated with symmetrical calcification of the basal ganglia are rare in children. This report concerns a 22-month-old female infant who was admitted with the problem of acute onset of status epilepticus. Physical examination revealed a grade II/VI heart systolic murmur over the left sternal border, and engorged scalp veins. Neurologically, left side hemiparesis, brisk deep tendon reflexes, bilateral presence of Babinski sign and ankle clonus were present. Brain computed tomography without contrast medium showed cortical atrophy and symmetrical calcification of the basal ganglia. Brain magnetic resonance imaging showed a signal-voided tortuous structure over the right parietal region. Cerebral angiography disclosed a dural arteriovenous malformation, located over the right parietal region, which had two major feeding arteries from the branch of the anterior cerebral artery and the parietal branch of the middle cerebral artery, and had direct venous drainage into the superior sagittal sinus. The patient received craniotomy with ligation of feeding arteries. She became seizure-free, and her neurological deficits improved gradually.