A case of a dural arteriovenous fistula presenting with progressive brain stem symptoms including dysphagia

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  • 進行する脳幹症状および嚥下障害を呈した硬膜動静脈瘻の1例

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A 69-year-old female with dural arteriovenous fistula presented with brain stem symptoms including rapidly progressive dysphagia. At first she complained of left tinnitus, vertigo and nausea in March 2007 and was admitted. Diplopia, left blepharoptosis, hoarseness and left-sided ataxia appeared on May 11. T2-weighted head MRI revealed hyperintense areas in the left medulla oblongata and pons, where DWI showed a slight degree of hyperintensity. It was therefore difficult to diagnose the patient's condition. Dysphagia appeared on May 15. A videoendoscopic examination of swallowing (VE) revealed features of left-sided pharyngo-laryngeal palsy, which thereafter rapidly deteriorated over the next 2 days. Therefore, she was treated by drip infusion and nasogastric tube feeding. The amount of sputum expectorated decreased on May 23 and she became able to swallow saliva. As a result, she then received food swallowing training. During the patient's course, the left sigmoid sinus was poorly visualized on contrast-enhanced MRI and DSA led to the diagnosis of a dural arteriovenous fistula of the left sigmoid sinus. On July 19, an embolization was performed, followed by rehabilitation. The left-sided ataxia, the loss of temperature and pain sensation on the right side of the body and left bulbar palsy remained, but the dysphagia markedly improved. She thereafter became able to ingest food orally, attained a T-cane gait indoors and achieved an independent ADL and was finally discharged to home.

Journal

  • OTOLOGIA FUKUOKA

    OTOLOGIA FUKUOKA 54 (6Supplement2), S162-S167, 2008

    JIBI TO RINSHO KAI

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