RT Journal Article
SR Electronic
T1 Dementia resulting from dural arteriovenous fistulas: the pathologic findings of venous hypertensive encephalopathy.
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 1267
OP 1273
VO 19
IS 7
A1 R W Hurst
A1 L J Bagley
A1 S Galetta
A1 G Glosser
A1 A P Lieberman
A1 J Trojanowski
A1 G Sinson
A1 M Stecker
A1 E Zager
A1 E C Raps
A1 E S Flamm
YR 1998
UL http://www.ajnr.org/content/19/7/1267.abstract
AB PURPOSE Dural arteriovenous fistulas (DAVFs) are acquired arteriovenous shunts located within the dura. The highly variable natural history and symptomatology of DAVFs range from subjective bruit to intracranial hemorrhage and are related to the lesion's pattern of venous drainage and its effect on the drainage of adjacent brain. We examined the prevalence and features of DAVFs in patients with progressive dementia or encephalopathy.METHODS The records and radiologic studies of 40 consecutive patients with DAVFs treated at our institution were reviewed.RESULTS Five (12.5%) of 40 consecutive patients with DAVFs had encephalopathy or dementia. In each patient, high flow through the arteriovenous shunt combined with venous outflow obstruction caused impairment of cerebral venous drainage. Hemodynamically, the result was widespread venous hypertension causing diffuse ischemia and progressive dysfunction of brain parenchyma. Results of CT or MR imaging revealed abnormalities in each patient, reflecting the impaired parenchymal venous drainage. Pathologic findings in one patient confirmed the mechanism of cerebral dysfunction as venous hypertension. The hemodynamic mechanism and resulting abnormality appeared identical to that seen in progressive chronic myelopathy resulting from a spinal DAVF (Foix-Alajouanine syndrome). Remission of cognitive symptoms occurred in each patient after embolization.CONCLUSION Venous hypertensive encephalopathy resulting from a DAVF should be considered a potentially reversible cause of vascular dementia in patients with progressive cognitive deficits.