AccScience Publishing / AN / Volume 3 / Issue 1 / DOI: 10.36922/an.0980
Cite this article
57
Download
1479
Views
Journal Browser
Volume | Year
Issue
Search
News and Announcements
View All
CASE REPORT

Seizure as the first symptom of cavernous sinus dural arteriovenous fistula: A case report and literature review

Mengxin Li1† Shuai Jia1† Jian Li1 Jianhong Geng1 Xiaojun Zhang1 Yanqiang Wang1*
Show Less
1 Department of Neurology II, The Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
Advanced Neurology 2024, 3(1), 0980 https://doi.org/10.36922/an.0980
Submitted: 23 May 2023 | Accepted: 12 October 2023 | Published: 9 November 2023
© 2023 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
Abstract

Cavernous sinus dural arteriovenous fistula (CS-DAVF) is an abnormal arteriovenous communication associated with a variety of clinical manifestations. The previous literature has rarely reported the occurrence of CS-DAVF with seizures and cerebral hemorrhage, signaling the need for more case reports and literature review in this area. A 62-year-old Chinese female presented with a paroxysmal loss of consciousness, accompanied with involuntary eye movement to the left, chewing issues, salivation at the right corner of the mouth, and bit tongue. The brain computed tomography revealed that the left temporal lobe was hemorrhagic. Brain scan and contrast-enhanced magnetic resonance imaging showed diffuse meningeal enhancement and lesions in the left frontoparietal temporal lobe, insular lobe, and hippocampal head region. Electroencephalography demonstrated continuous emission of spike and slow waves in the left hemisphere. With the aid of digital subtraction angiography, the patient was confirmed with a diagnosis of CS-DAVF draining into the ipsilateral cavernous sinus, intercavernous sinus, contralateral cavernous sinus, left superior ophthalmic vein, left lateral fissure vein, and left pterygoid venous plexus. The fistula was closed with interventional embolization through the femoral vein, and immediate angiography showed complete resolution of CS-DAVF after operation. The patient did not manifest any post-operative complications. This case highlights that the prevention of epilepsy, cerebral hemorrhage, and other serious complications is extremely important for good prognosis, especially in some patients presenting with serious clinical symptoms. It also sheds light on the necessity to consider the diagnosis of CS-DAVF if seizures, although extremely rare, are present.

Keywords
Cavernous sinus dural arteriovenous fistula
Epileptic seizures
Digital subtraction angiography
Interventional embolization
Case report
Funding
Clinical Research Center of Affiliated Hospital of Weifang Medical University
References
  1. Hou K, Li G, Luan T, et al., 2020, Endovascular treatment of the cavernous sinus dural arteriovenous fistula: Current status and considerations. Int J Med Sci, 17: 1121–1130. https://doi.org/10.7150/ijms.45210

 

  1. Tanioka S, Sato Y, Nampei M, et al., 2016, Cavernous sinus dural arteriovenous fistula presenting with intracerebral hemorrhage associated with chronological angiographic demonstration of disturbed leptomeningeal venous drainage as the sole outflow route. World Neurosurg, 95: 617. e7–617.e12. https://doi.org/10.1016/j.wneu.2016.08.077

 

  1. Iki Y, Morofuji Y, Somagawa C, et al., 2020, Surgical venous drainage disconnection from cavernous sinus dural arteriovenous fistula and ruptured varix. World Neurosurg, 137: 18–23. https://doi.org/10.1016/j.wneu.2020.01.058

 

  1. Ha JG, Jeong HW, In HS, et al., 2011, Transvenous embolization of cavernous sinus dural arteriovenous fistula using the direct superior ophthalmic vein approach: A case report. Neurointervention, 6: 100–103. https://doi.org/10.5469/neuroint.2011.6.2.100

 

  1. Alexander MD, Darflinger R, Cooke DL, et al., 2021, Cerebral arteriovenous fistulae. Handb Clin Neurol, 176: 179–198. https://doi.org/10.1016/B978-0-444-64034-5.00004-3

 

  1. Quaranta L, De Simone R, Tavanti F, et al., 2021, Focal status epilepticus in dural arteriovenous fistula detected after a two-step clinical course: A case report. Seizure, 86: 210–212. https://doi.org/10.1016/j.seizure.2021.01.015

 

  1. Cognard C, Gobin YP, Pierot L, et al., 1995, Cerebral dural arteriovenous fistulas: Clinical and angiographic correlation with a revised classification of venous drainage. Radiology, 194: 671–680. https://doi.org/10.1148/radiology.194.3.7862961

 

  1. Gross BA, Du R, 2012, The natural history of cerebral dural arteriovenous fistulae. Neurosurgery, 71: 594–602; discussion 602–603. https://doi.org/10.1227/NEU.0b013e31825eabdb

 

  1. Alexandre AM, Sturiale CL, Bartolo A, et al., 2021, Endovascular treatment of cavernous sinus dural arteriovenous fistulas. Institutional series, systematic review and meta-analysis. Clin Neuroradiol, 32: 761–771. https://doi.org/10.1007/s00062-021-01107-0

 

  1. Jin Y, Zhao C, Zhang S, et al., 2014, Seizure outcome after surgical resection of supratentorial cavernous malformations plus hemosiderin rim in patients with short duration of epilepsy. Clin Neurol Neurosurg, 119: 59–63. https://doi.org/10.1016/j.clineuro.2014.01.013.

 

  1. Hanael E, Baruch S, Chai O, et al., 2022, Detection of blood-brain barrier dysfunction using advanced imaging methods to predict seizures in dogs with meningoencephalitis of unknown origin. J Vet Intern Med, 36: 702–712. https://doi.org/10.1111/jvim.16396

 

  1. Greene C, Hanley N, Reschke CR, et al., 2022 Microvascular stabilization via blood-brain barrier regulation prevents seizure activity. Nat Commun, 13: 2003. https://doi.org/10.1038/s41467-022-29657-y

 

  1. Harding AE, Kendall B, Leonard TJ, et al., 1984, Intracerebral haemorrhage complicating dural arteriovenous fistula: A report of two cases. J Neurol Neurosurg Psychiatry, 47: 905–911. https://doi.org/10.1136/jnnp.47.9.905

 

  1. Sakuma I, Takahashi S, Tomura N, et al., 2006, Dural arteriovenous fistulas of the cavernous sinus with onset of intracerebral haemorrhage mimicking hypertensive putaminal hemorrhage. Acta Neurochir (Wien), 148: 915–918. https://doi.org/10.1007/s00701-006-0848-8

 

  1. Meguro T, Sasaki T, Haruma J, et al., 2011, A case of cavernous sinus dural arteriovenous fistula presenting with intracranial hemorrhage. No Shinkei Geka, 39: 687–692.

 

  1. Takazawa H, Kubo M, Kuwayama N, et al., 2005, Dural arteriovenous fistula involving the cavernous sinus as the cause of intracerebral venous hemorrhage: A case report. No Shinkei Geka, 33: 143–147.

 

  1. Akamatsu Y, Sato K, Endo H, et al., 2017, Single-session hematoma removal and transcranial coil embolization for a cavernous sinus dural arteriovenous fistula: A technical case report. World Neurosurg, 104:1046.e7–1046.e12. https://doi.org/10.1016/j.wneu.2017.04.009
Conflict of interest
The authors declare that they have no conflicts of interest.
Share
Back to top
Advanced Neurology, Electronic ISSN: 2810-9619 Published by AccScience Publishing