TY - JOUR
T1 - Medullary venous hypertension secondary to a petrous apex dural arteriovenous fistula
T2 - A case report
AU - Murphy, Meghan
AU - Van Gompel, Jamie J.
PY - 2012/9
Y1 - 2012/9
N2 - Background: Dural arteriovenous fistulae (dAVF) are common intracranial vascular lesions typically becoming symptomatic with cortical venous hypertension and possible hemorrhage. Here, we present a case illustration of a petrous apex dAVF with marked medullary venous hypertension and a unique clinical presentation. Methods: Case report. Results: A 72-year-old female, whose clinical progression was significant for altered mental status and progressive weakness, presented with diplopia, right leg paresis, and ataxia. Magnetic resonance imaging revealed edema involving the medulla. On digital subtraction cerebral angiogram, the patient was found to have a petrous apex dAVF, Cognard type IV. Following treatment with Onyx embolization, her symptoms rapidly improved, with complete resolution of diplopia and drastic improvement of her ataxia. Conclusion: The importance of this case is in the presentation and deterioration of the clinical exam, resembling an acute ischemic event. Further, this case illustrates that dAVF may cause venous hypertension with rapid onset of focal neurologic symptoms not exclusive to cortical locations.
AB - Background: Dural arteriovenous fistulae (dAVF) are common intracranial vascular lesions typically becoming symptomatic with cortical venous hypertension and possible hemorrhage. Here, we present a case illustration of a petrous apex dAVF with marked medullary venous hypertension and a unique clinical presentation. Methods: Case report. Results: A 72-year-old female, whose clinical progression was significant for altered mental status and progressive weakness, presented with diplopia, right leg paresis, and ataxia. Magnetic resonance imaging revealed edema involving the medulla. On digital subtraction cerebral angiogram, the patient was found to have a petrous apex dAVF, Cognard type IV. Following treatment with Onyx embolization, her symptoms rapidly improved, with complete resolution of diplopia and drastic improvement of her ataxia. Conclusion: The importance of this case is in the presentation and deterioration of the clinical exam, resembling an acute ischemic event. Further, this case illustrates that dAVF may cause venous hypertension with rapid onset of focal neurologic symptoms not exclusive to cortical locations.
KW - Dural arteriovenous fistula
KW - Onyx embolization
KW - Petrous apex
KW - Venous hypertension
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U2 - 10.1159/000343945
DO - 10.1159/000343945
M3 - Article
C2 - 23185173
AN - SCOPUS:84873108150
SN - 1662-680X
VL - 4
SP - 187
EP - 193
JO - Case Reports in Neurology
JF - Case Reports in Neurology
IS - 3
ER -