Reversible Parkinsonism and Rapidly Progressive Dementia Due to Dural Arteriovenous Fistula: Case Series and Literature Review - PubMed (original) (raw)
A: Axial noncontrast
CT
demonstrates a right anterior temporal intraparenchymal hematoma. There are dilated veins in the temporal lobe and interpeduncular cistern. B,C:
MRI DWI
(B) and T2‐weighted
FLAIR
(not shown) images demonstrate bilateral diffuse white matter hyperintensities, which are isointense on the
ADC
map (C). D: Initial angiogram demonstrates an extensive
dAVF
involving the right transverse, sigmoid, and torcular sinuses fed by bilateral occipital, middle meningeal, and tentorial arterial branches. Bilateral superficial temporal arteries and the right posterior auricular artery supply a second
dAVF
involving the superior sagittal sinus. There is segmental occlusion of both transverse sinuses, the left sigmoid, and the superior sagittal sinus, with retrograde flow into the straight sinus, vein of Galen, and pterygoid plexus, and marked cortical venous reflux into the cerebral and cerebellar hemispheres. E: Initial coil and Onyx embolization of the right transverse‐sigmoid and torcular sinuses. Follow‐up angiogram (not shown) demonstrated recurrence of right transverse sinus fistula. F: X‐ray shows dural puncture needle positioned in the right transverse sinus after burr hole access. G:
CT
angiogram demonstrates dilated tortuous veins in the posterior fossa. H,I:
MRI DWI
(H) shows high signal throughout the cerebral and cerebellar (not shown) parenchyma without restricted diffusion on the
ADC
map (I). J: Angiogram performed in the right occipital artery demonstrates marked fistulous filling of the right transverse‐sigmoid dural venous segments, with right sigmoid sinus occlusion, focal stenosis at the left transverse–sigmoid junction, and retrograde flow into the left transverse sinus, straight sinus, and vein of Galen. K: Postembolization angiogram (right common carotid injection) demonstrates complete occlusion of the
dAVF
with embolization coils.