© Georg Thieme Verlag KG Stuttgart · New York
Dural Arteriovenous Fistula Presenting as an Acute Subdural Hemorrhage that Subsequently Progressed to a Chronic Subdural Hemorrhage: Case Report
26 February 2009 (online)
Objective and Importance: Non-traumatic subdural hemorrhage (SDH) caused by dural arteriovenous fistula (DAVF) is rare and is usually accompanied by intracerebral hemorrhage (ICH) and/or subarachnoid hemorrhage (SAH). This report describes a very rare case of DAVF that caused non-traumatic acute SDH without ICH or SAH, which subsequently progressed into chronic SDH.
Case Report: The patient presented with a sudden-onset severe headache, and was diagnosed with acute SDH by computed tomography. Cerebral angiography showed a DAVF on the left convexity adjacent to the superior sagittal sinus (SSS). This DAVF drained to the SSS and to the pterygoid venous plexus via the left middle fossa without retrograde flow (Type I according to the Cognard classification). The SDH was thickest at the lower convexity, which suggested that the draining vein of the DAVF was responsible for the bleeding.
Intervention: The SDH slowly progressed for two weeks. The DAVF was successfully treated with transarterial embolization using n-butyl 2-cyanoacrylate. The SDH was resolved via burr-hole drainage surgery.
Conclusion: This is the first reported case of DAVF that caused non-traumatic progression to SDH. As DAVF can be the cause of acute and chronic SDH, cerebral angiography is recommended for non-traumatic acute SDH as well as for intractable chronic SDH.
embolization - dural arteriovenous fistula - subdural hematoma - subdural hemorrhage
- 1 Nishida A, Sugiu K, Katsumata A. et al . A review of dural arteriovenous fistulas with hemorrhagic onset. No Shinkei Geka. 2002; 30 1059-1064
- 2 Kuwayama N, Kubo M, Tsumura K. et al . Hemodynamic status and treatment of aggressive dural arteriovenous fistulas. Acta Neurochir Suppl. 2005; 94 123-126
- 3 Davies MA, TerBrugge K, Willinsky R. et al . The validity of classification for the clinical presentation of intracranial dural arteriovenous fistulas. J Neurosurg. 1996; 85 830-837
- 4 Cognard C, Gobin YP, Pierot L. et al . Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. Radiology. 1995; 194 671-680
- 5 Duffau H, Lopes M, Janosevic V. et al . Early rebleeding from intracranial dural arteriovenous fistulas: report of 20 cases and review of the literature. J Neurosurg. 1999; 90 78-84
- 6 Borden JA, Wu JK, Shucart WA. A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment. J Neurosurg. 1995; 82 166-179
- 7 Brown Jr RD, Wiebers DO, Nichols DA. Intracranial dural arteriovenous fistulae: angiographic predictors of intracranial hemorrhage and clinical outcome in nonsurgical patients. J Neurosurg. 1994; 81 531-538
- 8 Awad IA, Little JR, Akarawi WP. et al . Intracranial dural arteriovenous malformations: factors predisposing to an aggressive neurological course. J Neurosurg. 1990; 72 839-850
- 9 Pappas CT, Zabramski JM, Shetter AG. Iatrogenic arteriovenous fistula presenting as a recurrent subdural hematoma. Case report. J Neurosurg. 1992; 76 134-136
- 10 Kominato Y, Matsui K, Hata Y. et al . Acute subdural hematoma due to arteriovenous malformation primarily in dura mater: a case report. Leg Med (Tokyo). 2004; 6 256-260
- 11 Halbach VV, Higashida RT, Hieshima GB. et al . Treatment of dural arteriovenous malformations involving the superior sagittal sinus. AJNR Am J Neuroradiol. 1988; 9 337-343
- 12 Ito J, Imamura H, Kobayashi K. et al . Dural arteriovenous malformations of the base of the anterior cranial fossa. Neuroradiology. 1983; 24 149-154
- 13 Komiyama M, Yasui T, Tamura K. et al . Chronic subdural hematoma associated with middle meningeal arteriovenous fistula treated by a combination of embolization and burr hole drainage. Surg Neurol. 1994; 42 316-319
S. Kohyama, MD, PhD
Doctor’s Office 421
Division of Endovascular Neurosurgery
International Medical Center
Saitama Medical University
Phone: 81/42/984 00 73
Fax: +81/42/984 00 74