Progressive subcortical calcifications secondary to venous hypertension in an intracranial dural arteriovenous fistula

doi:10.1016/j.jocn.2017.01.019

Journal of Clinical Neuroscience

Volume 39, May 2017, Pages 98-101

https://doi.org/10.1016/j.jocn.2017.01.019 Get rights and content

Highlights

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Establishing the diagnosis of a dural arteriovenous fistula (dAVF) can be challenging.
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The most commonly reported findings on CT of a dAVF are haemorrhage and focal oedema.
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We describe a case of progressive subcortical calcifications on CT from a high grade dAVF.
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The calcifications are likely due to impaired cerebral perfusion from cortical venous reflux.
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Whilst not pathognomonic, such calcifications should raise the possibility of a dAVF.

Abstract

Intracranial dural arteriovenous fistulas (dAVF) are acquired lesions, with the most commonly reported findings on CT haemorrhage or focal oedema. We describe a case of progressive subcortical calcification on CT secondary to venous hypertension from a high grade dAVF.

Introduction

Dural arteriovenous fistulas (dAVF) account for 10–15% of cerebral vascular malformations [1]. Establishing a diagnosis is sometimes challenging, both clinically and radiologically. An early diagnosis is however beneficial, as dAVFs are potentially curable either by endovascular or neurosurgical intervention [2]. A non-contrast CT Brain is often the initial imaging performed and the most commonly reported findings are haemorrhage and focal oedema. Only a few case reports have described subcortical calcifications occurring in patients with a dAVF with associated cortical venous reflux (CVR) [2], [3], [4], [5].

Section snippets

Case report

A 63-year-old man presented to the emergency department with bifrontal headaches and visual changes. He had a history of sigmoid and transverse sinus thrombosis seven months earlier. MRI demonstrated a right occipital dAVF, bilateral sigmoid sinus thrombosis with partial occlusion of the left and extensive bilateral cortical vein engorgement suggesting CVR. Catheter angiogram confirmed a right transverse sinus dAVF with CVR (Cognard grade 2a + b) (Fig. 1). There was CVR and reflux into the

Discussion

CT scans in this case demonstrate curvilinear calcifications in the subcortical white-matter believed to be secondary to impaired cerebral perfusion in the setting of a dAVF. Whilst the precise aetiology of calcifications is yet to be elucidated, it has been postulated that they result either from chronic venous congestion with calcification occurring secondary to dystrophic changes in the walls of the congested veins or as a result of an arterial steal phenomenon with calcification occurring

Conflicts of interest/disclosures

The authors declare that they have no financial or other conflicts of interest in relation to this research and its publication.

References (5)

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Involvement of dural arteries in intracranial arteriovenous malformations
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M. Wilson et al.
Intracranial dural arterio-venous fistula
Pract Neurol
(2008)

There are more references available in the full text version of this article.

Cited by (3)

An aggressive dural arteriovenous fistula manifested by unilateral subcortical calcification and cerebral edema: A case report
2023, Radiology Case Reports
Unilateral subcortical calcifications are unique radiographic findings indicating specific focal pathologies. When the lesion is accompanied by edema, cerebral neoplasm usually leads to a differential diagnosis. This report presents a case of unilateral subcortical calcification and edema that resulted in cerebral hemorrhage and a subsequent diagnosis of an aggressive dural arteriovenous fistula. A man in his 60s presented with left hemianopsia and a progressive headache for over 6 months. Initial computed tomography revealed unilateral subcortical calcification and cerebral edema in the right occipital lobe, raising the suspicion of oligodendroglioma. However, 10 days later, a cerebral hemorrhage occurred in the lesion. Magnetic resonance imaging revealed flow void clusters and dilatation of the bilateral external carotid arteries and cortical veins, indicating a dural arteriovenous fistula. Cerebral angiography confirmed the presence of a parasagittal dural arteriovenous fistula (Borden type III). The patient was successfully treated with trans-arterial embolization using Onyx. Thus, calcifications with edema are more commonly associated with cerebral neoplasms; however, in this case, they indicated the presence of a dural arteriovenous fistula with severe corticovenous reflux. The presented case highlights the importance of recognizing these imaging features in dural arteriovenous fistulas and raises awareness of the potential danger of early hemorrhage after diagnosis. Therefore, timely evaluation of cranial vessels is essential in cases of unilateral subcortical calcification and edema to facilitate the early detection and management of aggressive dural arteriovenous fistulas.
Subcortical calcification on CT in Borden type III intracranial dural arteriovenous fistula
2019, Clinical Neurology
Progress in research on intracranial multiple dural arteriovenous fistulas
2018, Biomedical Reports

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Case reportProgressive subcortical calcifications secondary to venous hypertension in an intracranial dural arteriovenous fistula

Highlights

Abstract

Introduction

Section snippets

Case report

Discussion

Conflicts of interest/disclosures

Involvement of dural arteries in intracranial arteriovenous malformations

Radiology

Intracranial dural arterio-venous fistula

Pract Neurol

Case report
Progressive subcortical calcifications secondary to venous hypertension in an intracranial dural arteriovenous fistula