Successful endovascular treatment of a deep cerebral arteriovenous fistula with unusual venous drainage
Introduction
The most common method of disconnecting an arteriovenous fistula is occluding its arterial supply either by clipping surface vessels or using endovascular techniques [2], [3], [4], [5], [6], [7], [8], [9]. The purpose of this report is to present the radiologic features of a deep cerebral arteriovenous fistula in an adult with unusual venous drainage following into the supratentorial deep venous system and into the infratentorial cerebellar veins, including findings of brain computed tomography, magnetic resonance image and cerebral angiography and its successful percutaneous embolization using NBCA and platinum coils.
Section snippets
Case report
This 35-year-old male was admitted to our hospital after a sudden episode of headache, vomiting, dysarthria and ataxia of gait so that he could not walk without aided. On physical examination the patient's blood pressure is 101/65 mmHg. The neurologic examination disclosed bilateral ataxia of his extremities. The CT scan demonstrated bilateral intracerebellar hemorrhage (Fig. 1A). Magnetic resonance imaging (MRI) disclosed an intracerebellar hematoma and flow-void structures in the deep cerebral
Discussion
Arteriovenous fistulas of the brain are rare lesions that have been recognized as distinct or multiple and can be associated with cerebral arterialvenous malformation [1], [4], [7], [9]. They can be asymptomatic or, more often, can cause increased intracranial pressure, seizure, cerebral hemorrhage, cardiac decompression for which treatment is necessary [1], [3], [4], [7], [9].
Little is known concerning the mechanism of the symptomatology of cerebral arteriovenous fistula. Some patients develop
Conclusion
Direct cerebral arteriovenous fistula is rare; it can present with intracranial hemorrhage and can be treated successfully by endovascular embolization therapy. NBCA and Onyx can be used implementely in treatment of cerebral arteriovenous malformation.
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