[Case of traumatic dural arteriovenous fistula presenting as an acute subdural hematoma and an intracerebral hematoma. A case report]

Abstract

A rare case of traumatic dural arteriovenous fistula presenting as an acute subdural hematoma and an intracerebral hematoma is reported. A 57-year-old man was admitted to our hospital complaining of aphasia and right hemiparesis. A CT on admission demonstrated a left frontotemporal subdural hematoma and an intracerebral hematoma in the left frontal lobe. Left external carotid angiographies revealed a dural arteriovenous fistula, fed by the left middle meningeal artery and draining the middle meningeal vein. A retrograde drainage into the cortical vein was also revealed. The patient had sudden loss of consciousness after cerebral angiography and demonstrated increased subdural hematoma and severe midline shift. We performed emergency decompressive craniectomy, coagulation of the dural vessels, and evacuation of the subdural hematoma. Postoperative left external carotid angiographies revealed the disappearance of the dural arteriovenous fistula. This case suggested a dural arteriovenous fistula, between the middle meningeal artery and the middle meningeal vein close to the sinus (sphenoparietal or superior sagital sinus), and resulted in a subdural hematoma and an intracerebral hematoma, due to the retrograde venous drainage into cortical veins.