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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 22:273-276 (2 2001)
© 2001 American Society of Neuroradiology

ARTICLE

An Adult Case of Congenital External Carotid–Jugular Arteriovenous Fistula with Reversible Circulatory Insufficiency in the Cerebellum and Lower Brain Stem

Masahiro Horiuchi^,a, Tsutomu Kamo^a, Hiroshi Sugihara^a, Koshiro Fujisawa^a, Yoichi Takahashi^a, Ritsuko Ikeda^a, Hiroyuki Morishima^a and Yoshitaro Yamaguchi^a

^a From the Departments of Internal Medicine (M.H., T.K., H.S., K.F., Y.T.) and Neurosurgery (R.I., H.M., Y.Y.), St. Marianna University School of Medicine, Kawasaki, Japan.

Summary: A 27-year-old man with congenital external carotid–jugular arteriovenous fistula presented with a diminished level of consciousness and an ataxic gait. Axial fluid-attenuated inversion-recovery (FLAIR) MR imaging revealed venous congestion, a dilated right jugular vein, and an area of high signal intensity in the brain stem and cerebellum. Angiography showed a dilated right external carotid artery and jugular vein and the presence of a fistula. After coil embolization of the fistula, axial MR FLAIR images showed only a few areas of high signal intensity in the brain stem and cerebellum. The causal factor was venous congestion in the inferior petrosal sinus and basilar plexus due to high blood pressure in the jugular vein. This case is presented for its unusual clinical and radiologic findings.