Arnaldo Brito1, Anderson Chun On Tsang2, Christopher Hilditch3, Patrick Nicholson3, Timo Krings3, Waleed Brinjikji3. 1. Department of Radiology, Clínica Colsanitas, Fundación Universitaria Sanitas, Bogotá, Colombia. Electronic address: aa.britoa@unisanitas.edu.co. 2. Division of Neuroradiology, Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, Department of Surgery, University of Hong Kong, Hong Kong, China. 3. Division of Neuroradiology, Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
Abstract
OBJECTIVE: Intracranial dural arteriovenous fistulas (DAVFs) can manifest with a reversible form of dementia and parkinsonism that may be related to medullary venous hypertension and impaired cortical venous drainage. We report a consecutive case series of patients with DAVFs who presented with cognitive decline and report angioarchitecture and outcomes of treatment. METHODS: From a prospectively collected database of 389 cranial DAVFs, we identified patients who presented with progressive dementia. Data collected included demographic characteristics, other presenting symptoms, fistula location and type, preoperative and postoperative imaging findings, and treatment outcomes. Descriptive statistics were reported. RESULTS: Of 389 patients with DAVF, 6 patients with progressive dementia (1.4%) were identified. All patients were male. Mean patient age was 68.6 years. Four patients had superior sagittal sinus DAVFs, 1 patient had a tentorial DAVF, and 1 patient had a transverse sinus DAVF. All patients had evidence of medullary venous hypertension on imaging with either reflux and arterialization of the transmedullary veins or venous congestion of the transmedullary veins. All patients underwent endovascular treatment and had reversal of dementia-related symptoms after a mean follow-up of 6.2 months. CONCLUSIONS: Cognitive decline is a rare but reversible manifestation of DAVFs that have impaired venous drainage of the transmedullary veins and associated medullary venous hypertension.
OBJECTIVE:Intracranial dural arteriovenous fistulas (DAVFs) can manifest with a reversible form of dementia and parkinsonism that may be related to medullary venous hypertension and impaired cortical venous drainage. We report a consecutive case series of patients with DAVFs who presented with cognitive decline and report angioarchitecture and outcomes of treatment. METHODS: From a prospectively collected database of 389 cranial DAVFs, we identified patients who presented with progressive dementia. Data collected included demographic characteristics, other presenting symptoms, fistula location and type, preoperative and postoperative imaging findings, and treatment outcomes. Descriptive statistics were reported. RESULTS: Of 389 patients with DAVF, 6 patients with progressive dementia (1.4%) were identified. All patients were male. Mean patient age was 68.6 years. Four patients had superior sagittal sinus DAVFs, 1 patient had a tentorial DAVF, and 1 patient had a transverse sinus DAVF. All patients had evidence of medullary venous hypertension on imaging with either reflux and arterialization of the transmedullary veins or venous congestion of the transmedullary veins. All patients underwent endovascular treatment and had reversal of dementia-related symptoms after a mean follow-up of 6.2 months. CONCLUSIONS:Cognitive decline is a rare but reversible manifestation of DAVFs that have impaired venous drainage of the transmedullary veins and associated medullary venous hypertension.
Authors: K D Bhatia; H Lee; H Kortman; J Klostranec; W Guest; T Wälchli; I Radovanovic; T Krings; V M Pereira Journal: AJNR Am J Neuroradiol Date: 2021-10-21 Impact factor: 3.825
Authors: Anirudh Arun; Matthew R Amans; Nicholas Higgins; Waleed Brinjikji; Mithun Sattur; Sudhakar R Satti; Peter Nakaji; Mark Luciano; Thierry Agm Huisman; Abhay Moghekar; Vitor M Pereira; Ran Meng; Kyle Fargen; Ferdinand K Hui Journal: Neuroradiol J Date: 2021-07-05