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Saleh T, Albalkhi I, Matrushi M, Al Mubarak F, Al-Saadi T. Coexistence of Intracranial Dural Arteriovenous Fistula and Cerebral Venous Sinus Thrombosis: Systematic Review and Outcome Analysis. World Neurosurg 2024:S1878-8750(24)01184-7. [PMID: 39002775 DOI: 10.1016/j.wneu.2024.07.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 07/04/2024] [Accepted: 07/04/2024] [Indexed: 07/15/2024]
Abstract
A substantial number of patients with intracranial dural arteriovenous fistula (dAVF) suffer from coexistent cerebral venous sinus thrombosis (CVST), yet this clinical relation is poorly studied. We aim to study the clinical and radiological outcome of patients with coexistent dAVF and CVST based on different treatment modalities and to examine various other parameters in such patients. A search strategy was performed on the following search engines: PubMed, Wiley, Microsoft Academia, and Google Scholar. Analysis was performed using R software. Thirty-five articles met the inclusion criteria. Most studies (n = 30) used digital subtraction angiography alone to make the diagnosis. Treatment modality ranged from no treatment (n = 7) to a combination of anticoagulation, endovascular therapy, and surgery (n = 2). Radiological obliteration was achieved in the majority of patients (78%). However, there was no statistical significance between treatment modality and radiological outcome (P=0.651); 72% of patients achieved clinical improvement, with no statistical significance between clinical improvement and treatment modality (P=0.072). We did find a significant relationship between treatment modality and follow-up findings (P=0.023). When analyzing factors such as age, gender, grade, arterial supply, and time between dAVF and CVST development, we found no statistical significance. Additionally, there was no significant association between the grade of fistula and the treatment modality. The clinical relationship between dAVF and CVST is poorly studied. This is the first systematic review that aimed to study this relationship. Results from subsequent large-scale studies comparing to our findings are warranted.
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Affiliation(s)
- Tariq Saleh
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Mira Matrushi
- College of Medicine & Health Science, National University of Science & Technology, Sohar, Oman
| | | | - Tariq Al-Saadi
- Department of Neurosurgery, Montreal Neurological Institute and Hospital, Montreal, Canada; Department of Neurosurgery, McGill University, Montreal, Canada; Neurosurgery Department, Khoula Hospital, Muscat, Oman.
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Wan S, Han G, Huang X, Guo Y, Chen J, Zhou D, Wu C, Ji X, Ding Y, Meng R. Dural Arteriovenous Fistulas With or Without Cerebral Venous Thrombosis: A Cross-Sectional Analysis of 511 Patients. Neurosurgery 2024; 94:771-779. [PMID: 37930149 PMCID: PMC10914226 DOI: 10.1227/neu.0000000000002748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/19/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Recent studies suggest a bidirectional relationship of dural arteriovenous fistula (DAVF) with cerebral venous thrombosis (CVT). We aimed to compare the characteristics of patients with DAVF with or without CVT and to analyze the risk factors for the coexistence of CVT in a DAVF population. METHODS A total of 511 adult patients with DAVF were enrolled consecutively in our hospital from February 2019 through November 2022. Demographic data, clinical manifestations, and imaging characteristics were reviewed in detail. The patients with DAVF were divided into two groups: DAVF with CVT (DAVF-CVT) group and without CVT (DAVF alone) group. Univariate logistic regression and multivariate logistic regression were used to analyze the risk factors for the coexistence of CVT and DAVF. RESULTS CVT was found in 19.8% of patients with DAVF. In univariate analysis, compared with the DAVF-alone group, the DAVF-CVT group was more likely to have tinnitus ( P = .001), blurred vision ( P < .001), visual field loss ( P = .001), focal neurological deficits ( P = .002), seizures ( P = .008), and cognitive impairment ( P = .046) and less likely to have spinal cord/brain stem dysfunction ( P = .004). In addition, there were significant differences in age ( P = .009), sex ( P = .019), the occurrence of venous cerebral infarction ( P = .001), and DAVF location ( P < .001) between the two groups. Furthermore, multivariate analysis showed that blurred vision, venous cerebral infarction, large sinus DAVF, and multiple DAVF were risk factors for the coexistence of CVT in patients with DAVF, with the odds ratio of 2.416 (95% CI 1.267-4.606, P = .007), 6.018 (95% CI 1.289-28.100, P = .022), 5.801 (95% CI 2.494-13.496, P < .001), and 5.640 (95% CI 2.122-14.989, P = .001), respectively. CONCLUSION CVT occurred in approximately one fifth of patients with DAVF. Blurred vision, venous cerebral infarction, large sinus DAVF, and multiple DAVF may be the risk factors for predicting the coexistence of CVT in patients with DAVF.
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Affiliation(s)
- Shuling Wan
- Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Guangyu Han
- Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Xiangqian Huang
- Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Yibing Guo
- Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Jian Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Da Zhou
- Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Chuanjie Wu
- Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Xunming Ji
- Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Ran Meng
- Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
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Paudyal MB, Bhattarai M, Mehta N, Gautam N, Baral B, Sharma NK, Basnet R, Ghimire B. Coexistence of cerebral venous thrombosis and dural arteriovenous fistula in an adolescent: A case report. Clin Case Rep 2023; 11:e7916. [PMID: 37720711 PMCID: PMC10500052 DOI: 10.1002/ccr3.7916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/25/2023] [Accepted: 09/04/2023] [Indexed: 09/19/2023] Open
Abstract
Key Clinical Message Clinicians should consider central venous thrombosis (CVT) as a differential diagnosis in young adolescents with persistent headaches. It is essential to assess for concurrent CVT and dural arteriovenous fistula (DAVF), particularly in those with a history of CVT. Abstract Cerebral venous thrombosis (CVT) and dural arteriovenous fistula (DAVF) are uncommon vascular disorders with diverse clinical presentations. The coexistence of CVT and DAVF is a rare but important association that may impact the management and prognosis of affected patients. Prothrombotic conditions generally ranging from acquired to genetic, oral contraceptives, malignancy, puerperium, infection, and head injury are the common risk factors for cerebral venous thrombosis. Here, we present a case of 18 years males who developed recurrent cerebral thrombosis on the background of the presence of an arteriovenous fistula.
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Affiliation(s)
- Man Bahadur Paudyal
- Maharajgunj Medical CampusTribhuvan University, Institute of MedicineMaharajgunjNepal
| | - Madhur Bhattarai
- Maharajgunj Medical CampusTribhuvan University, Institute of MedicineMaharajgunjNepal
| | - Neha Mehta
- Maharajgunj Medical CampusTribhuvan University, Institute of MedicineMaharajgunjNepal
| | - Niraj Gautam
- Department of NeurologyTribhuvan University Teaching Hospital, Institute of MedicineMaharajgunjNepal
| | - Bikas Baral
- Maharajgunj Medical CampusTribhuvan University, Institute of MedicineMaharajgunjNepal
| | - Niraj Kumar Sharma
- Maharajgunj Medical CampusTribhuvan University, Institute of MedicineMaharajgunjNepal
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Huang X, Shen H, Fan C, Chen J, Meng R. Clinical characteristics and outcome of dural arteriovenous fistulas secondary to cerebral venous sinus thrombosis: a primary or secondary event? BMC Neurol 2023; 23:131. [PMID: 36997877 PMCID: PMC10061836 DOI: 10.1186/s12883-023-03141-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 02/27/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND The Dural Arteriovenous Fistulas (DAVFs) secondary to cerebral venous sinus thrombosis (CVST) are rather rare. The aim of present study is to investigate the clinical and radiological features, and treatment outcome of DAVFS in patients following CVST. METHODS Data about demographic information, clinical presentations, radiological findings, as well as treatment and outcome of DAVFs sequence to CVST were collected to analysis from January 2013 to September 2020 in this retrospective study. RESULTS Fifteen patients with DAVFs after CVST were included in the study. The median age was 41 years (range17-76 years). Ten patients (66.67%) were male and 6 patients (33.33%) were female. The median duration of presenting CVST was 182 days (Range 20-365). Mean time from diagnosis of CVST to confirmation of DAVFs was 97 days (range 36-370 days). The most common manifestations of DAVFs following CVST were headache and visual disturbance seen in 7 patients respectively. Five patients had pulsatile tinnitus (%) and 2 had nausea/vomiting. The DAVFs are most frequently located at the transverse/sigmoid sinus (7/15, 46.67%), followed by the superior sagittal the sinus and confluence sinus (6/15, 40.00%) respectively. Angiography of DAVFs revealed Board type I in seven (46.7%) patients, Board type II and III in 4(26.7%) patients, respectively. The Cognard I was noted in seven (46.7%), Cognard IIa and IV in 3 patients, IIb and III in one patient, respectively. The main feeding arteries of DAVFs most commonly originate from the branches of the external carotid artery in 6 (40.0%) patients. The other DAVFs are conjointly supplied by multiple feeders from internal and external carotid artery and vertebral arteries. Fourteen (93.33%) patients were treated with endovascular embolization and none of the patients had permanent deficits during follow-up. CONCLUSION Intracranial DAVFs following CVST are rare presentations. Most patients have a good outcome after timely interventional therapy. Continued observation and follow-up of (DSA) are important to find DAVFs secondary to CVST.
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Affiliation(s)
- Xiaoqin Huang
- Departments of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
| | - Huixin Shen
- Departments of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chunnqiu Fan
- Departments of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jian Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ran Meng
- Departments of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
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Li X, Dong J, Sun Y, Li Q, Shi L. Relationship between cerebral venous sinus thrombosis and intracranial arteritis during pregnancy and post partum. J Investig Med 2021; 69:1367-1371. [PMID: 34380631 DOI: 10.1136/jim-2020-001757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2021] [Indexed: 11/04/2022]
Abstract
Our study was conducted to explore the relationship between cerebral venous sinus thrombosis (CVST) and intracranial arteritis during the time of pregnancy as well as puerperium. The current retrospective case study involved a total of 153 patients with pregnancy-related CVST. CVST was diagnosed mainly based on clinical manifestations and imaging results. Detailed information on demographics, risk factors (excluding intracranial arteritis), and pregnancy outcomes was systematically recorded. The average age of patients diagnosed with CVST was 28.67±3.54 years old. Among these patients, there were 62 cases of puerperal CVST and 91 cases of pregnancy-related CVST. The clinical manifestations of patients with CVST included headache in 55 cases (35.95%), symptomatic seizures in 26 cases (16.99%), symptomatic limb weakness in 22 cases (14.38%), symptomatic nausea/vomiting in 18 cases (11.76%), symptomatic disturbance of consciousness in 15 cases (9.80%), symptomatic blurred vision in 10 cases (6.54%), and symptomatic fever in 7 cases (4.58%). A proportion of patients reported higher abnormal cerebrospinal fluid pressure (98.28%), white cell count (79.31%), total cholesterol (71.55%) and low-density lipoprotein (62.93%) (p<0.01). The proportion of intracranial arteritis lesions and CVST lesions was high, including 51 cases (43.97%) on the left side and 31 cases (26.72%) on the right side. Bilateral CVST lesions occurred in 13 cases (11.20%) of unilateral intracranial arteritis lesions, and bilateral intracranial arteritis lesions occurred in 16 cases (13.79%) of unilateral CVST lesions. In summary, CVST indicates a potential positive link to intracranial arteritis at the time of pregnancy and puerperium.
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Affiliation(s)
- Xiurong Li
- Department of Obstetrics and Gynecology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jianan Dong
- Department of Obstetrics and Gynecology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yaping Sun
- Department of Obstetrics and Gynecology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Qing Li
- Department of Obstetrics and Gynecology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Li Shi
- Department of Obstetrics and Gynecology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Yang S, You R, Wu W, Wei Z, Hong M, Peng Z. Dural Arteriovenous Fistula Complicated with Cerebral Venous Sinus Thrombosis. World Neurosurg 2020; 134:348-352. [PMID: 31639507 DOI: 10.1016/j.wneu.2019.10.075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 10/12/2019] [Accepted: 10/13/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND Cerebral venous sinus thrombosis (CVST) is always confused with dural arteriovenous fistula (DAVF) in clinical practice; however, both of them are very rare cerebral vascular diseases. In this report, we provide one case of DAVF combined with CVST. CASE DESCRIPTION A 75-year-old woman complained of headache with nausea and vomiting for 4 days. Magnetic resonance venography revealed filling defect in the torcular, left transverse, and sigmoid sinus, which strongly suggested sinus thrombosis. The patient underwent anticoagulation treatment for 9 days. However, the manifestation was not alleviated, magnetic resonance imaging detected the lesion was enlarged, and the midline shifted to the left. Digital subtraction angiography examination detected that one fistula classified as Borden type IA was fed by the left superficial temporal artery and drained into the left transverse and sigmoid sinus. Endovascular embolization with ethylene vinyl alcohol was conducted. CONCLUSIONS Follow-up at 6 months indicated that the patient recovered without any sequelae.
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Affiliation(s)
- Sujuan Yang
- Department of Neurology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Rongjiao You
- Department of Neurology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Weifeng Wu
- Department of Neurology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Zhisheng Wei
- Department of Neurology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Mingfan Hong
- Department of Neurology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Zhongxing Peng
- Department of Neurology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China.
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Huang Q, Chai X, Xiao C, Cao X. A case report of oral contraceptive misuse induced cerebral venous sinus thrombosis and dural arteriovenous fistula. Medicine (Baltimore) 2019; 98:e16440. [PMID: 31415348 PMCID: PMC6831267 DOI: 10.1097/md.0000000000016440] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
RATIONALE Consumption of oral contraceptive pills (OCP) is a known risk factor for cerebral venous sinus thrombosis (CVST) among women. Development of dural arteriovenous fistula (dAVF) afterwards was very uncommon. We present a rare chronic complication of development of dAVF after CVST. PATIENT CONCERNS A 22-year-old woman suffered headache for a week. She was then admitted into our hospital. DIAGNOSIS Contrast enhanced magnetic resonance venography (MRV) demonstrated the thrombosis of the left transverse-sigmoid sinus the second day. INTERVENTIONS The intravenous thrombolysis was carried out. As the symptoms improved, the patient was discharged, while the treatment with oral dabigatran continued. However, 3 months after the onset, magnetic resonance imaging (MRI) showed swelling brainstem, and digital subtraction angiography (DSA) confirmed a dAVF. Clipping of the fistula was conducted, and her clinical symptoms improved gradually. OUTCOMES The patient was transferred to rehabilitation center later, and received follow-up care. LESSONS When a patient taking OCP and suffering from a sudden headache, a clinical suspicion of possible CVST should always arise to avoid the onset of dAVF as soon as possible.
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Affiliation(s)
- Qingling Huang
- Department of Radiology, Nanjing Medical University Affiliated Nanjing Brain Hospital, Nanjing, China
| | - Xue Chai
- Department of Radiology, Nanjing Medical University Affiliated Nanjing Brain Hospital, Nanjing, China
| | - Chaoyong Xiao
- Department of Radiology, Nanjing Medical University Affiliated Nanjing Brain Hospital, Nanjing, China
| | - Xuan Cao
- Department of Mathematical Sciences, University of Cincinnati, Cincinnati, OH
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Zhang H, Zhang X, Zheng D. Superior sagittal sinus thrombosis as a rare complication of spontaneous intracranial hypotension syndrome: a case report and review of the literature. Int J Neurosci 2018; 129:401-405. [PMID: 30345841 DOI: 10.1080/00207454.2018.1538144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
In addition to an orthostatic headache, spontaneous intracranial hypotension syndrome can lead to subdural hematoma and diffusion, subarachnoid hemorrhage, and brain sag. However, cerebral venous sinus thrombosis is rarely reported in patients with spontaneous intracranial hypotension. We present the case of a 35-year-old male who developed an orthostatic headache, nausea, vomiting, and photophobia for 5 days. An enhanced brain magnetic resonance image showed extensive linear pachymeningeal enhancement in the bilateral cerebral hemispheres. Lumbar puncture showed that cerebrospinal fluid pressure was 80 mmH2O. Subsequent magnetic resonance scans demonstrated subdural effusion of the bilateral frontoparietal lobes, hyperintense T1-weighted images, and T2WI lesions within the superior sagittal sinus in 17 days. The patient was given low molecular weight heparin and adverse events occurred. Head computed tomography showed cerebral external fluid accumulation in the bilateral frontoparietal lobes. Then, digital subtraction angiography was performed at 22 days, which confirmed superior sagittal sinus thrombosis, and the patient recovered fully after therapy. The evolution of the disease and radiological findings support the diagnosis of spontaneous intracranial hypotension with superior sagittal sinus thrombosis. To the best of our knowledge, there are very few case reports describing superior sagittal sinus thrombosis as a complication of spontaneous intracranial hypotension. When spontaneous intracranial hypotension and cerebral venous thrombosis occur together, difficult practical questions arise regarding the treatment of these two conditions.
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Affiliation(s)
- Han Zhang
- a Department of Neurology , Shengjing Hospital of China Medical University , Tiexi District , Shenyang , China
| | - Xiaotian Zhang
- a Department of Neurology , Shengjing Hospital of China Medical University , Tiexi District , Shenyang , China
| | - Dongming Zheng
- a Department of Neurology , Shengjing Hospital of China Medical University , Tiexi District , Shenyang , China
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