Dementia resulting from dural arteriovenous fistulas: the pathologic findings of venous hypertensive encephalopathy.
Publication/Presentation Date
8-1-1998
Abstract
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.
Volume
19
Issue
7
First Page
1267
Last Page
1273
ISSN
0195-6108
Published In/Presented At
Hurst, R. W., Bagley, L. J., Galetta, S., Glosser, G., Lieberman, A. P., Trojanowski, J., Sinson, G., Stecker, M., Zager, E., Raps, E. C., & Flamm, E. S. (1998). Dementia resulting from dural arteriovenous fistulas: the pathologic findings of venous hypertensive encephalopathy. AJNR. American journal of neuroradiology, 19(7), 1267–1273.
Disciplines
Diagnosis | Medicine and Health Sciences | Other Analytical, Diagnostic and Therapeutic Techniques and Equipment | Radiology
PubMedID
9726465
Department(s)
Department of Radiology and Diagnostic Medical Imaging
Document Type
Article