Venous ischemia caused by dural arteriovenous malformation. Case report

A case is presented of tentorial dural arteriovenous malformation (AVM) associated with visual hallucinations and quadrant hemianopsia. Computerized tomography (CT) and magnetic resonance imaging showed an ischemic region, mainly affecting the white matter of the right occipital lobe, that was defined as an area of increased blood volume on dynamic CT scans and as a decrease in cerebral blood flow on N-isopropyl-p-123I-iodoamphetamine single-photon emission CT scans. Angiography demonstrated venous congestion, probably because the retrograde arterial inflow from the dural AVM into the corticomedullary vein was direct and not via the sinuses. The symptoms and radiological findings improved immediately after endovascular treatment. The origin of these symptoms was fully evaluated and confirmed to be a reversible ischemic change caused by disturbance of the volume of venous return over an extensive area.