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 Kamoa,
Hiroshi Sugiharaa,
Koshiro Fujisawaa,
Yoichi Takahashia,
Ritsuko Ikedaa,
Hiroyuki Morishimaa and
Yoshitaro Yamaguchia
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.
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FIG 1. 27-year-old man with congenital external carotid–jugular arteriovenous fistula who presented with a diminished level of consciousness and an ataxic gait.
A, Axial FLAIR MR images (6000/120) on the day of hospital admission show venous congestion, a dilated right jugular vein, and an area of high signal intensity in the brain stem and cerebellum. A small infarction is visible in the temporal lobe.
B and C, Angiograms, frontal (B) and lateral (C) views, 1 day after admission show a dilated right external carotid artery and internal jugular vein and the presence of a fistula.
D, Brain CT studies 5 hours after angiography show congestion and edema.
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FIG. 1 Continued.
E, Axial FLAIR MR images (6000/120) after embolization show only a few areas of high signal intensity in the brain stem and cerebellum.
F, Angiogram 1 month after admission shows that the external carotid artery and jugular vein are almost equivalent in size, and no arteriovenous communication is detected.
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