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Tatezuki J, Pak S, Ohgaki F, Takemoto Y, Mochimatsu Y. Convexity Dural Arteriovenous Fistula without Cortical Venous Reflux Presenting with Pure Acute Subdural Hematoma. NMC Case Rep J 2024; 11:37-41. [PMID: 38454912 PMCID: PMC10917653 DOI: 10.2176/jns-nmc.2023-0220] [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: 09/25/2023] [Accepted: 11/19/2023] [Indexed: 03/09/2024] Open
Abstract
Hemorrhagic changes in a dural arteriovenous fistula are typically associated with cortical venous reflux and occur as intracerebral or subarachnoid hemorrhages. A convexity dural arteriovenous fistula (DAVF) usually flows directly into the cortical veins and exhibits cortical venous reflux. Herein, we report a rare case of a convexity DAVF without cortical venous reflux presenting with a pure acute subdural hematoma. A 19-year-old man complaining of headache without any history of head injury was diagnosed with a left acute subdural hematoma on magnetic resonance imaging (MRI) and referred to our hospital. The patient was conscious and exhibited no neurological signs. The MRI did not reveal any possible abnormalities leading to hemorrhage. Cerebral angiography revealed a dural arteriovenous fistula in the left parietal cranium with a feeder from the middle meningeal artery and a drainer into the main transverse sinus via a diploic vein. Part of the shunt blood flowed into the superior sagittal sinus from the meningeal vein; however, there was no reflux into the cortical vein or stasis of the cerebral vein, suggesting venous hypertension. A convexity DAVF was diagnosed as the source of bleeding, and transarterial embolization was performed. The patient recovered without any neurological deficits. In the absence of trauma, an acute subdural hematoma requires an appropriate evaluation of the vascular lesions and a treatment plan.
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Affiliation(s)
- Junya Tatezuki
- Department of Neurosurgery, Yokohama City Minato Red Cross Hospital, Yokohama, Kanagawa, Japan
| | - Sujong Pak
- Department of Neurosurgery, Yokohama City Minato Red Cross Hospital, Yokohama, Kanagawa, Japan
| | - Fukutaro Ohgaki
- Department of Neurosurgery, Yokohama City Minato Red Cross Hospital, Yokohama, Kanagawa, Japan
| | - Yasunori Takemoto
- Department of Neurosurgery, Yokohama City Minato Red Cross Hospital, Yokohama, Kanagawa, Japan
| | - Yasuhiko Mochimatsu
- Department of Neurosurgery, Yokohama City Minato Red Cross Hospital, Yokohama, Kanagawa, Japan
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Tabibian BE, Liptrap E, Jones J. Incidentally discovered dural arteriovenous fistula during middle meningeal artery embolization for the treatment of chronic subdural hematoma. Surg Neurol Int 2021; 12:438. [PMID: 34513201 PMCID: PMC8422413 DOI: 10.25259/sni_183_2021] [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: 02/20/2021] [Accepted: 05/15/2021] [Indexed: 11/07/2022] Open
Abstract
Background: The incidence of chronic subdural hematoma (CSDH) is increasing with population age and anticoagulant use. Embolization of the middle meningeal artery (MMA) is an emerging, less invasive alternative to open surgery in treating this condition. Dural arteriovenous fistula (DAVF) is a rare condition whose association with CSDH is not well understood. We present three cases with incidentally discovered DAVFs during MMA embolization for the treatment of CSDH that necessitated adjustments to initial treatment strategy. Case Descriptions: We retrospectively reviewed all MMA embolizations performed for the treatment of CSDH beginning in 9/2019 to 11/2020. Imaging and hospital course of three cases of incidentally discovered DAVF, including patient demographics, clinical presentation, methods of treatment, imaging and outcome were assessed. Thirty MMA embolizations were performed as primary or adjunct treatment of CSDH. DAVF was discovered angiographically in 3 (10%) cases. All patients reported a history of prior closed head injury, although the timing of injury and subdural blood product age did not correlate in 2 of the 3 cases. All subjects experienced complete symptomatic and radiographic resolution of the subdural hematoma and DAVF following intervention. Conclusion: As MMA embolization for CSDH becomes more frequent, so may the incidental diagnosis of DAVF. Awareness of this potential association is critical to diagnosing DAVF with angiography and altering treatment strategies as needed.
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Affiliation(s)
- Borna Ethan Tabibian
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Elizabeth Liptrap
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Jesse Jones
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, United States
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Dominguez JF, Shah S, Ampie L, Chen X, Li B, Ng C, Feldstein E, Wainwright JV, Schmidt M, Cole C, Koo DC, Chadha B, Lee J, Yarrabothula A, Rao N, Adkoli A, Miller I, Gandhi CD, Al-Mufti F, Santarelli J, Bowers C. Spinal Epidural Abscess Patients Have Higher Modified Frailty Indexes Than Back Pain Patients on Emergency Room Presentation: A Single-Center Retrospective Case-Control Study. World Neurosurg 2021; 152:e610-e616. [PMID: 34129981 DOI: 10.1016/j.wneu.2021.06.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Spinal epidural abscess (SEA) patients have increased medical comorbidities and risk factors for infection compared with those without SEA. However, the association between frailty and SEA patients has not been documented. METHODS A total of 46 SEA patients were randomly paired and matched by age and sex with a control group of patients with back pain who had presented to our emergency department from 2012 to 2017. Statistical analysis identified the risk factors associated with SEA and frailty using the modified frailty index (mFI), and the patients were stratified into robust, prefrail, and frail groups. We examined the value of the mFI as a prognostic predictor and evaluated the classic risk factors (CRFs). RESULTS The SEA patients had higher mFIs and CRFs (P = 0.023 and P < 0.001, respectively) and a longer length of stay (22.89 days vs. 1.72 days; P < 0.001). Of the mFI variables, only diabetes had a significant association with SEA (odds ratio [OR], 3.60; P = 0.012). Among the stratified mFI subgroups, a frail ranking (mFI >2) was the strongest risk factor for SEA (OR, 5.18; P = 0.003). A robust ranking (mFI, 0-1) was a weak negative predictor for SEA (OR, 0.41; P = 0.058). The robust patients were also more likely to be discharged to home (OR, 7.58; P = 0.002). Of the CRF variables, only intravenous drug use had a statistically significant association with SEA (OR, 10.72; P = 0.015). CONCLUSIONS Patients with SEA were more frail compared with the control back pain patients. Frailty was determined to be an independent risk factor for SEA, outside of the CRFs. The use of the mFI could be potentially useful in predicting the diagnosis, prognosticating, and guiding SEA treatment.
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Affiliation(s)
- Jose F Dominguez
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, New York, USA.
| | - Smit Shah
- Department of Neurology, University of South Carolina, Columbia, South Carolina, USA
| | - Leonel Ampie
- Department of Neurosurgery, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Xintong Chen
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Boyi Li
- School of Medicine, New York Medical College, Valhalla, New York, USA
| | - Christina Ng
- School of Medicine, New York Medical College, Valhalla, New York, USA
| | - Eric Feldstein
- School of Medicine, New York Medical College, Valhalla, New York, USA
| | - John V Wainwright
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | - Meic Schmidt
- Department of Neurosurgery, School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Chad Cole
- Department of Neurosurgery, School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Donna C Koo
- School of Medicine, New York Medical College, Valhalla, New York, USA
| | - Bhawneet Chadha
- School of Medicine, New York Medical College, Valhalla, New York, USA
| | - Joo Lee
- School of Medicine, New York Medical College, Valhalla, New York, USA
| | | | - Naina Rao
- School of Medicine, New York Medical College, Valhalla, New York, USA
| | - Anusha Adkoli
- School of Medicine, New York Medical College, Valhalla, New York, USA
| | - Ivan Miller
- Department of Emergency Medicine, Westchester Medical Center, Valhalla, New York, USA
| | - Chirag D Gandhi
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | - Fawaz Al-Mufti
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | - Justin Santarelli
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | - Christian Bowers
- Department of Neurosurgery, School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA
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Isolated subdural hematoma secondary to Dural arteriovenous fistula: a case report and literature review. BMC Neurol 2019; 19:43. [PMID: 30898107 PMCID: PMC6427890 DOI: 10.1186/s12883-019-1272-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 03/12/2019] [Indexed: 12/05/2022] Open
Abstract
Background Dural arteriovenous fistula (DAVF) is an uncommon subtype among the intracranial arteriovenous malformations, which is characterized by pathological anastomoses between meningeal arteries and dural venous sinuses, meningeal veins, or cortical veins. While intracerebral hemorrhage accounts for most of the hemorrhagic cases in patients with DAVF, isolated subdural hematoma (SDH) is rarely reported. Case presentation A 45-year-old man was admitted for a progressively worsening headache over 2 weeks. Head computed tomography on admission revealed an isodense chronic SDH (CSDH) on the left hemisphere with mild midline shift. Further angiography of the external carotid artery revealed a DAVF at the transverse sinus. The DAVF was embolized via the middle meningeal artery. His CSDH gradually resolved without surgical intervention. In order to further elucidate this rare entity, a review of relevant literature was also conducted. Conclusions Isolated SDH is a rare complication of DAVF. In this report, we presented a rare case of CSDH secondary to an intracranial DAVF. According to this case report and our literature review, the so-called benign type of DAVF without cortical venous drainage does not always warrant a benign process and might be complicated with SDH. Careful preoperative investigation is needed for relative young patients presenting with idiopathic or atypical SDH.
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