Dural arteriovenous fistula presenting with exophthalmos and seizures

Abstract

Concomitant seizures and exophthalmos in the context of a temporal dural arteriovenous fistula (dAVF) has not been described before. Here, we report a 55-year-old-male who presented with an 8-month history of progressive painless exophthalmos of his left eye, conjunctival chemosis, reduced vision and new onset complex partial seizures. Cerebral angiography demonstrated Cognard Type IIa left cerebral dAVF fed by branches from the left occipital artery and an accessory meningeal artery, with drainage to the superior ophthalmic vein. Following surgical obliteration of dAVF feeding vessels, our patient had dramatic improvement in visual acuity, proptosis and chemosis along with cessation of clinical seizures.

Introduction

Dural arteriovenous fistulas (dAVFs) are rare dural-based pathologic shunts representing 10–15% of all cerebrovascular malformation [1]. Although there are several classification systems for intracranial dAVFs, Cognard classification (Types I–V) that correlates with venous drainage patterns with increasingly aggressive neurological clinical course, is most widely used and accepted [2]. dAVFs can also be classified based on their location: transverse-sigmoid sinus, cavernous sinus, tentorum cerebri, superior sagittal sinus and anterior cranial fossa dAVFs. Concomitant seizures and exophthalmos in the context of direct carotid-cavernous sinus dAVF was reported once [3]; however, this association has not been described with a temporal dAVF. Herein, we report a patient with a dAVF who presented with an 8-month history of progressive painless exophthalmos of his left eye, conjunctival chemosis, reduced vision and new onset complex partial seizures (CPS).