Recurring Thalamic Symptoms Due to Intracranial Dural Arteriovenous Fistula: Report of Unusual Case and Treatment Outcome

Initial clinical presentation of dural arteriovenous fistula (DAVF) with predominantly thalamic symptoms is rare and has not been reported until now. A young child presenting with complaints of tinnitus and mild right hemiparesis was evaluated with an initial magnetic resonance imaging, which reveal...

Full description

Saved in:
Bibliographic Details
Published in:World neurosurgery 2018-10, Vol.118, p.9-13
Main Authors: Vinayagamani, Selvadasan, Kannath, Santhosh Kumar, Rajan, Jayadevan Enakshy
Format: Article
Language:English
Subjects:
Aphasia - diagnostic imaging
Aphasia - etiology
Aphasia - surgery
Arteriovenous Fistula - complications
Arteriovenous Fistula - diagnostic imaging
Arteriovenous Fistula - surgery
Child, Preschool
Dural arteriovenous fistula
Humans
Intracranial Arteriovenous Malformations - complications
Intracranial Arteriovenous Malformations - diagnostic imaging
Intracranial Arteriovenous Malformations - surgery
Male
Recurrence
Thalamic Diseases - diagnostic imaging
Thalamic Diseases - etiology
Thalamic Diseases - surgery
Thalamic symptoms
Thalamus - diagnostic imaging
Treatment Outcome
Venous aneurysm embolization
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Initial clinical presentation of dural arteriovenous fistula (DAVF) with predominantly thalamic symptoms is rare and has not been reported until now. A young child presenting with complaints of tinnitus and mild right hemiparesis was evaluated with an initial magnetic resonance imaging, which revealed a Borden type 2 DAVF in the right transverse sinus with retrograde venous drainage and cortical venous reflux. Flow-related small aneurysms were also noted in the left basal vein of Rosenthal (BVR). Two days later, his motor power deteriorated and he developed right hemisensory loss and severe thalamic pain. Aphasia was atypical and mimicked the transcortical type. Repeat imaging revealed expanding thrombosed aneurysm of BVR with mass effect and edema on thalamocapsular region. Initial antiedema measures reversed the neurologic deficits; however, they recurred, necessitating an urgent endovascular intervention. Angiogram revealed an extensive high-flow DAVF in the right transverse-sigmoid sinus and torcula with preferential retrograde venous drainage into deep veins and left BVR. He underwent staged embolization of DAVF, resulting in significant obliteration of shunt. Neurologic deficits improved in the postoperative period, and the patient remained clinically asymptomatic at 6 months of follow-up. DAVF presenting with recurrent predominantly thalamic symptoms is rare. Atypical transcortical aphasia rather than fluent aphasia is an unusual clinical manifestation of thalamic pathology and could result from the involvement of specific thalamic nuclei. Preferential high flow into BVR in the presence of venous anomalies could potentially induce architectural weakness of the venous wall and precipitate aneurysm formation. Embolization of the DAVF can potentially reverse this unusual neurologic condition. •Recurring thalamic symptoms are rare clinical manifestation of intracranial dural arteriovenous fistula.•Episodic mass effect on thalamus by venous aneurysm of basal vein of Rosenthal can be the cause for this unusual presentation.•Hemodynamic stress due to preferential arterialized flow into BVR might precipitate aneurysm formation at acute curvatures.•Thalamic aphasia can rarely mimic transcortical variety, possibly due to involvement of specific thalamic nuclei.•Embolization of the fistula could potentially reverse this unusual neurologic condition.
ISSN:1878-8750
1878-8769
DOI:10.1016/j.wneu.2018.06.187