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      A Case of Dural Arteriovenous Fistula Presenting as Acute Subdural Hematoma

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          Abstract

          Dural arteriovenous fistula (AVF) presenting with subdural hematoma is relatively rare. We report a case of dural AVF presenting as acute subdural hematoma (ASDH) and provide a review of the literature. A 56-year-old man presented with disturbance of consciousness. Computed tomography demonstrated a right ASDH and a small right occipital subcortical hematoma. Cerebral angiography showed a dural AVF on the occipital convexity draining into the cortical veins. Emergent endovascular embolization was immediately performed and the shunt flow disappeared. Hematoma removal and external decompression were safely conducted. Combined therapy successfully recovered the patient's consciousness level. This rare case of dural AVF presenting with ASDH was treated with combined treatments of endovascular and open surgery.

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          Most cited references 5

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          Dural arteriovenous malformations and intracranial hemorrhage.

          Intracranial hemorrhage is seen less frequently with dural than with intraparenchymal arteriovenous malformations (AVMs). We report 6 cases of intracranial hemorrhage among our past 10 patients with dural AVMs. A literature search provided 27 other cases of intracranial hemorrhage from a total of 213 reported dural AVMs. Although hemorrhage was relatively infrequent (7.5%) with dural AVMs located primarily within a major venous sinus, bleeding episodes occurred in 20 of the 39 (51%) cases of malformation outside a major sinus. There was primary leptomeningeal venous drainage in all cases with hemorrhage, and a large variceal dilatation was seen in 14 cases (42%). Dural AVMs located outside a major sinus are uncommon, and they have a propensity for serious intracranial hemorrhage.
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            Acute subdural hematoma due to arteriovenous malformation primarily in dura mater: a case report.

            We report a 42-year-old female with alcohol addiction who suddenly died of subdural hematoma (SDH) caused by dural arteriovenous malformation (AVM). In autopsy, there was seen a massive SDH with a total weight of 181 g that covered an entire part of the left cerebral hemisphere, although either serious external injuries of the head or any visible internal injuries of the brain were observed. SDH subsequently resulted in the tonsillar, transtentorial and subfalcial herniations with a right-sided shift of the left-lateral and third ventricles, and the left thalamus as well. Histopathological examination on the serial sections cut from the falx cerebri revealed abnormal distribution of arteries and veins with various sizes, which were comprehensively highlighted by immunohistochemical stainings with alpha-SMA and CD31. Although a very point of bleeding was not identified even by careful histological observation, we concluded that dural AVM could be critical for acute SDH in the present case. The value of ethanol concentration examined in the samples from SDH supported that the lesion could be not chronic, but acute.
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              Dural arteriovenous fistula on the convexity presenting with pure acute subdural hematoma.

              Non-traumatic dural arteriovenous fistula/malformation (dural AVF/AVM) presenting with pure subdural hematoma (SDH) is relatively rare. We report on a male patient who showed pure acute SDH and was diagnosed as having dural AVF on the convexity near the superior sagittal sinus (SSS), based on angiographic findings. A 27-year-old man was admitted to our hospital due to headache with acute onset. The patient did not have a history of head trauma or injury. Head CT showed an abnormal high-density area on the surface of the cerebral hemisphere on the left side, indicating acute SDH. Angiography during the arterial phase demonstrated that an abnormal artery originating from the left occipital artery was connected with a dural vein and a diploic vein on the convexity near the SSS. We concluded that a dural AVF existed at this area, and that the dural AVF had caused the acute SDH. Dural AVF/AVM which causes non-traumatic SDH is usually accompanied by intracerebral hemorrhage (ICH) and/or subarachnoid hemorrhage (SAH). In contrast, non-traumatic dural AVF/AVM presenting with pure SDH is rare, and our patient represents such a rare case. We should consider dural AVF/AVM and perform angiography if necessary when we encounter a patient showing non-traumatic SDH without ICH and/or SAH.
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                Author and article information

                Journal
                CRN
                CRN
                10.1159/issn.1662-680X
                Case Reports in Neurology
                S. Karger AG
                1662-680X
                2014
                January – April 2014
                30 April 2014
                : 6
                : 1
                : 122-125
                Affiliations
                Department of Neurosurgery, Aomori Prefectural Central Hospital, Aomori, Japan
                Author notes
                *Atsushi Saito, MD, PhD, Department of Neurosurgery, Aomori Prefectural Central Hospital, 2-1-1 Higashitsukurimichi, Aomori 0308553 (Japan), E-Mail satsushi2002@yahoo.co.jp
                Article
                362116 PMC4036125 Case Rep Neurol 2014;6:122-125
                10.1159/000362116
                PMC4036125
                24926261
                © 2014 S. Karger AG, Basel

                Open Access License: This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) ( http://www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 1, Tables: 1, Pages: 4
                Categories
                Published: April 2014

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