Dural Arteriovenous Fistula Presenting with Brain Stem Hemorrhage : A Report of 2 Cases

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  • 脳幹出血をきたした硬膜動静脈瘻の2例

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We report 2 cases of dural arteriovenous fistula with brain stem hemorrhage. One patient presented with dysarthric speech and clumsy right hand. A cranial CT revealed pontine hemorrhage. A left external carotid angiogram showed a dural arteriovenous fistula of the isolated sigmoid sinus fed mainly by the occipital artery, and draining into the superior petrosal vein, transverse pontine vein (with a varix), lateral mesencephalic vein and basal vein. The right occipital artery was then catheterized with a microcatheter and the fistula was embolized with a single injection of liquid material. A follow-up angiogram showed complete obliteration of the fistula. The second patient was referred to our hospital because of chemosis and exophthalmos of the right eye. Gradient echo T2-weighted MR images demonstrated a hypointense area in the pons, which suggested hemorrhage. A cerebral angiogram confirmed the diagnosis of a CCF draining into the superior petrosal vein, lateral pontine vein, and cerebellar cortical veins. Subsequently, transvenous coil packing was performed. Ocular symptoms completely disappeared after the embolization, and the patient was discharged without any symptoms of brain stem hemorrhage. However, a follow-up MR with gradient echo T2-weighted images still demonstrated hypointense area in the pons. Dural arteriovenous fistulas with cortical venous drainage or with venous ectasia demand urgent treatment due to the risk of hemorrhage or rebleeding.

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