TY - JOUR
T1 - High-grade dural arteriovenous fistula simulating a bilateral thalamic neoplasm
AU - Sugrue, Patrick A.
AU - Hurley, Michael C.
AU - Bendok, Bernard R.
AU - Surdell, Daniel L.
AU - Gottardi-Littell, Numa
AU - Futterer, Stephen F.
AU - Muro, Kenji
AU - Batjer, H. Hunt
PY - 2009/9
Y1 - 2009/9
N2 - Dural arteriovenous fistulae (dAVF) provide a diagnostic challenge and must be part of a broad differential in pursuit of a difficult diagnosis or unusual presentation. This case report demonstrates an initially misguided diagnosis of bilateral thalamic neoplasm and demonstrates the importance of continued pursuit until the correct diagnosis is obtained. Moreover, to our knowledge, this is the first reported case of a dAVF simulating a bilateral thalamic neoplasm. We present a patient with a provisional diagnosis of bilateral thalamic neoplasm based on clinical history and an advanced imaging workup including MR spectroscopy. Subsequent biopsy suggested venous congestion, hypoxia, and edema without neoplasia. Routine post-operative CT the following day revealed suggestion of dAVF due to the presence of residual contrast from prior unrelated abdominal CT. Cerebral angiography eventually revealed a Cognard grade IIb dAVF. Trans-arterial Onyx embolization resulted in a dramatic clinical and radiographic improvement. This case highlights an unusual presentation and challenging diagnosis of a dAVF and the importance of pursuing the correct diagnosis.
AB - Dural arteriovenous fistulae (dAVF) provide a diagnostic challenge and must be part of a broad differential in pursuit of a difficult diagnosis or unusual presentation. This case report demonstrates an initially misguided diagnosis of bilateral thalamic neoplasm and demonstrates the importance of continued pursuit until the correct diagnosis is obtained. Moreover, to our knowledge, this is the first reported case of a dAVF simulating a bilateral thalamic neoplasm. We present a patient with a provisional diagnosis of bilateral thalamic neoplasm based on clinical history and an advanced imaging workup including MR spectroscopy. Subsequent biopsy suggested venous congestion, hypoxia, and edema without neoplasia. Routine post-operative CT the following day revealed suggestion of dAVF due to the presence of residual contrast from prior unrelated abdominal CT. Cerebral angiography eventually revealed a Cognard grade IIb dAVF. Trans-arterial Onyx embolization resulted in a dramatic clinical and radiographic improvement. This case highlights an unusual presentation and challenging diagnosis of a dAVF and the importance of pursuing the correct diagnosis.
KW - Dementia
KW - Dural arteriovenous fistula
KW - Magnetic resonance spectroscopy
KW - Neoplasm
KW - Onyx
KW - Stereotactic brain biopsy
KW - Thalamus
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U2 - 10.1016/j.clineuro.2009.05.004
DO - 10.1016/j.clineuro.2009.05.004
M3 - Article
C2 - 19482418
AN - SCOPUS:67650443974
SN - 0303-8467
VL - 111
SP - 629
EP - 632
JO - Clinical Neurology and Neurosurgery
JF - Clinical Neurology and Neurosurgery
IS - 7
ER -