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Case Reports
. 2017 Apr-Jun;12(2):287-289.
doi: 10.4103/1793-5482.146399.

A rare case of dural arteriovenous fistula presenting as primary intraventricular hemorrhage

Trilochan Srivastava  1 , Raghavendra Bakki Sannegowda  1 , V D Sinha  2 , R S Jain  1 , Rahul Jain  1 , Tarun Mathur  1
Affiliations
Case Reports

A rare case of dural arteriovenous fistula presenting as primary intraventricular hemorrhage

Trilochan Srivastava et al. Asian J Neurosurg. 2017 Apr-Jun.

Abstract

Primary intraventricular haemorrhage (PIVH) is rare. Dural arteriovenous fistula causing PIVH is extremely rare. We report a case of a 17 year old boy who presented with left hemiparesis, left lower motor neuron facial palsy and ataxia. His computed tomography head revealed primary intraventricular hemorrhage. Catheter super selective angiography revealed a dural arterio venous fistula with arterial feeder arising from the middle meningeal artery as well as from the inferior marginal tentorial artery. Glue injection led to successful disappearance of the fistula and eventual clinical recovery.

Keywords: Arterio-venous fistula; catheter angiography; cortico-venous reflux; primary intraventricular hemorrhage; venous sinuses.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Brain noncontrast computed tomography showing blood in the fourth ventricle (a) and occipital horns of the fourth ventricle (b) and normal brain computed tomography angiography (c)
Figure 2
Figure 2
Right internal carotid artery injection showed prominent inferior marginal tentorial artery arising from the cavernous segment of internal carotid artery, filling the venous sinuses (transverse and sigmoid sinus junction)
Figure 3
Figure 3
Right external carotid artery artery injection arterial phase showing the internal maxillary artery (arrow), middle meningeal artery (open arrow) and filling of the fistula (arrow head) (a) with cortical venous reflux (b) and drainage into the transverse and sigmoid sinuses (c)
Figure 4
Figure 4
Superselective micro catheterization of the right middle meningeal artery (MMA) confirmed that the fistula was filling from the right MMA (a). Catheter was further advanced to the fistulous site and glue was injected with lipidol (50/50 ratio) (b) following which the fistula as well as the corticovenous reflux disappeared (c)
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