Dural arteriovenous fistulas

"Dural arteriovenous fistulas are abnormal communications, within the dural leaflets, between meningeal arteries and dural venous sinuses and/or subarachnoid veins." They can present anywhere within the intracranial dura matter but most common locations are the cavernous sinus, cribriform plate, transverse sigmoid sinus, and tentorium. (Elhammady et al, 2017)

DAVFs may lead to rapidly progressive cognitive impairment, a potentially reversible dementia (Geschwind et al, 2016).

• Clinical presentation (Elhammady et al, 2017)
  • Presentation depends on location of the fistula
    • antegrade drainage into the dural sinus usually present with headaches, pulsatile tinnitus, and bruits
    • retrograde sinus drainage, however, can lead to increased intracranial pressure with symptoms/signs of pseudotumor cerebri, severe headaches, papilledema, and possible cognitive decline and dementia. Some develop hemorrhagic or nonhemorrhagic neurological deficits, seizures, parkinsonism, or ataxia
• Diagnosis
  • Digital subtraction angiography is gold standard for evaluating suspected DAVF (Elhammady et al, 2017)
  • MRI findings include high intensity in cerebral/cerebellar white matter w/ enlarged vessels over hemispheric surface or rarely basal ganglia hyperintensity.
• Treatment (Geschwind 2016)
  • embolization, surgery, or embolization and surgery have led to improvement.

References

Elhammady MS, Ambekar S, Heros RC. Epidemiology, clinical presentation, diagnostic evaluation, and prognosis of cerebral dural arteriovenous fistulas. Handb Clin Neurol. 143:99-105 (2017)

Geschwind MD. Rapidly progressive dementia. Continuum. Apr:22(2 Dementia):510-537 (2016). https://pubmed.ncbi.nlm.nih.gov/27042906/