Journal article
Dural arteriovenous fistula-induced thalamic dementia: report of 4 cases
Journal of neurosurgery, Vol.124(6), pp.1752-1765
06/2016
DOI: 10.3171/2015.5.JNS15473
PMID: 26587655
Abstract
Nonhemorrhagic neurological deficits are underrecognized symptoms of intracranial dural arteriovenous fistulas (dAVFs) having cortical venous drainage. These symptoms are the consequence of cortical venous hypertension and portend a clinical course with increased risk of neurological morbidity and mortality. One rarely documented and easily misinterpreted type of nonhemorrhagic neurological deficit is progressive dementia, which can result from venous hypertension in the cortex or in bilateral thalami. The latter, which is due to dAVF drainage into the deep venous system, is the less common of these 2 dementia syndromes. Herein, the authors report 4 cases of dAVF with venous drainage into the vein of Galen causing bithalamic edema and rapidly progressive dementia. Two patients were treated successfully with endovascular embolization, and the other 2 patients were treated successfully with endovascular embolization followed by surgery. The radiographic abnormalities and presenting symptoms rapidly resolved after dAVF obliteration in all 4 cases. Detailed descriptions of these 4 cases are presented along with a critical review of 15 previously reported cases. In our analysis of these 19 published cases, the following were emphasized: 1) the clinical and radiographic differences between dAVF-induced thalamic versus cortical dementia syndromes; 2) the differential diagnosis and necessary radiographic workup for patients presenting with a rapidly progressive thalamic dementia syndrome; 3) the frequency at which delays in diagnosis occurred and potentially dangerous and avoidable diagnostic procedures were used; and 4) the rapidity and completeness of symptom resolution following dAVF treatment.
Details
- Title: Subtitle
- Dural arteriovenous fistula-induced thalamic dementia: report of 4 cases
- Creators
- Terrence F Holekamp - Departments of 1 Neurological SurgeryMatthew E Mollman - Departments of 1 Neurological SurgeryRory K J Murphy - Departments of 1 Neurological SurgeryGrant R Kolar - ImmunologyNeha M Kramer - Neurology, andColin P Derdeyn - Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, Missouri; andChristopher J Moran - Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, Missouri; andRichard J Perrin - Pathology, Washington University School of Medicine in St. LouisKeith M Rich - Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, Missouri; andGiuseppe Lanzino - Department of Neurological Surgery, Mayo Clinic, Rochester, MinnesotaGregory J Zipfel - Neurology, and
- Resource Type
- Journal article
- Publication Details
- Journal of neurosurgery, Vol.124(6), pp.1752-1765
- Publisher
- United States
- DOI
- 10.3171/2015.5.JNS15473
- PMID
- 26587655
- ISSN
- 0022-3085
- eISSN
- 1933-0693
- Language
- English
- Date published
- 06/2016
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984020761202771
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