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CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(01): 144-154
DOI: 10.4103/ajns.AJNS_317_19
Case Report

Reversible thalamic dementia caused by venous hypertension of bilateral thalami resulting from multiple intracranial dural arteriovenous fistulas successfully obliterated by endovascular treatment using liquid embolic materials: A case report and literature review

Prasert Iampreechakul
Department of Neurosurgery, Prasat Neurological Institute, Bangkok
,
Punjama Lertbutsayanukul
1   Department of Neuroradiology, Prasat Neurological Institute, Bangkok
,
Yodkwhan Wattanasen
1   Department of Neuroradiology, Prasat Neurological Institute, Bangkok
,
Thon Thiraworawong
2   Department of Neurology, Prasat Neurological Institute, Bangkok
,
Surasak Komonchan
2   Department of Neurology, Prasat Neurological Institute, Bangkok
,
Somkiet Siriwimonmas
3   Department of Radiology, Bumrungrad International Hospital, Bangkok
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We describe a patient with multiple cranial dural arteriovenous fistulas (DAVFs) presenting with thalamic dementia. A 52-year-old man experienced progressive dementia and behavioral change for 1 month. Cranial computed tomography scan and magnetic resonance imaging (MRI) showed bilateral thalamic edema with subsequent hemorrhagic transformation. Cerebral angiography demonstrated multiple cranial DAVFs at the straight sinus and posterior part of the superior sagittal sinus. The symptomatic fistula was the straight sinus DAVF, Cognard Type II a + b, supplied by meningeal branches of the left superior cerebellar artery, the left ascending pharyngeal artery originating from the left occipital artery, and multiple tiny branches of the left occipital artery with retrograde venous drainage into the straight sinus and vein of Galen. In addition, there was probable thrombosis at the middle part of the straight sinus associated with anatomical variation of the dural venous sinuses at the torcular herophili. The patient underwent successfully endovascular treatments in a two-staged embolization using liquid embolic materials. The patient has gradually recovered and could get back to the activities of daily living at home within 2 months. Follow-up MRI of the brain at 6 months revealed nearly complete resolution of the bilateral thalamic congestion. Cerebral angiography, obtained 1 year after endovascular treatment, confirmed complete obliteration of both DAVFs. We also reviewed the literature of thalamic dementia caused by intracranial DAVFs.

Key-words:

Endovascular treatment - multiple intracranial dural arteriovenous fistulas - tentorial dural arteriovenous fistula - thalamic dementia

Financial support and sponsorship

Nil.




Publication History

Received: 27 October 2019

Accepted: 11 December 2019

Article published online:
16 August 2022

© 2020. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Lasjaunias P, Berenstein A, Ter Brugge KG. Surgical Neuroangiography. Vol. 2.2. New York: Springer-Verlag; 2004.
  • 2 Lasjaunias P, Chiu M, ter Brugge K, Tolia A, Hurth M, Bernstein M. Neurological manifestations of intracranial dural arteriovenous malformations. J Neurosurg 1986;64:724-30.
  • 3 Barnwell SL, Halbach VV, Dowd CF, Higashida RT, Hieshima GB, Wilson CB. Multiple dural arteriovenous fistulas of the cranium and spine. AJNR Am J Neuroradiol 1991;12:441-5.
  • 4 van Dijk JM, TerBrugge KG, Willinsky RA, Wallace MC. Multiplicity of dural arteriovenous fistulas. J Neurosurg 2002;96:76-8.
  • 5 Guo Y, Yu J, Zhao Y, Yu J. Progress in research on intracranial multiple dural arteriovenous fistulas. Biomed Rep 2018;8:17-25.
  • 6 Lawton MT, Sanchez-Mejia RO, Pham D, Tan J, Halbach VV. Tentorial dural arteriovenous fistulae: Operative strategies and microsurgical results for six types. Neurosurgery 2008;62:110-24.
  • 7 Lewis AI, Tomsick TA, Tew JM Jr. Management of tentorial dural arteriovenous malformations: Transarterial embolization combined with stereotactic radiation or surgery. J Neurosurg 1994;81:851-9.
  • 8 Holekamp TF, Mollman ME, Murphy RK, Kolar GR, Kramer NM, Derdeyn CP, et al. Dural arteriovenous fistula-induced thalamic dementia: Report of 4 cases. J Neurosurg 2016;124:1752-65.
  • 9 Hurst RW, Bagley LJ, Galetta S, Glosser G, Lieberman AP, Trojanowski J, et al. Dementia resulting from dural arteriovenous fistulas: The pathologic findings of venous hypertensive encephalopathy. AJNR Am J Neuroradiol 1998;19:1267-73.
  • 10 Gonçalves MB, Maia O Jr., Correa JL, Siqueira SB, Christoph Dde H, Landeiro JA. Dural arteriovenous fistula presenting as thalamic dementia. Arq Neuropsiquiatr 2008;66:264-7.
  • 11 de Medeiros FC, de Albuquerque LA. Differential diagnosis in bilateral thalamic infarct: Clinical and radiological aspects. Acta Neurol Belg 2015;115:367-9.
  • 12 Crawford SC, Digre KB, Palmer CA, Bell DA, Osborn AG. Thrombosis of the deep venous drainage of the brain in adults. Analysis of seven cases with review of the literature. Arch Neurol 1995;52:1101-8.
  • 13 Sugrue PA, Hurley MC, Bendok BR, Surdell DL, Gottardi-Littell N, Futterer SF, et al. High-grade dural arteriovenous fistula simulating a bilateral thalamic neoplasm. Clin Neurol Neurosurg 2009;111:629-32.
  • 14 Nakada T, Kwee IL, Ellis WG, St John JN. Subacute diencephalic necrosis and dural arteriovenous malformation. Neurosurgery 1985;17:653-6.
  • 15 Ito M, Sonokawa T, Mishina H, Sato K. Reversible dural arteriovenous malformation-induced venous ischemia as a cause of dementia: Treatment by surgical occlusion of draining dural sinus: Case report. Neurosurgery 1995;37:1187-91.
  • 16 Iwama T, Hashimoto N, Takagi Y, Tanaka M, Yamamoto S, Nishi S, et al. Hemodynamic and metabolic disturbances in patients with intracranial dural arteriovenous fistulas: Positron emission tomography evaluation before and after treatment. J Neurosurg 1997;86:806-11.
  • 17 Tanaka K, Morooka Y, Nakagawa Y, Shimizu S. Dural arteriovenous malformation manifesting as dementia due to ischemia in bilateral thalami. A case report. Surg Neurol 1999;51:489-93.
  • 18 Greenough GP, Mamourian A, Harbaugh RE. Venous hypertension associated with a posterior fossa dural arteriovenous fistula: Another cause of bithalamic lesions on MR images. AJNR Am J Neuroradiol 1999;20:145-7.
  • 19 Tamamoto F, Nakanishi A, Takanashi T, Ishizaki H, Nagasawa H, Maehara T, et al. Unexpected accumulation of thallium-201 in bilateral thalamic venous infarction induced by arteriovenous fistula in the posterior fossa: Report of a case. Ann Nucl Med 2003;17:239-43.
  • 20 Tominaga T, Shamoto H, Shimizu H, Watanabe M, Yoshimoto T. Selective loss of Purkinje cells in transverse and sigmoid dural arteriovenous fistulas. Report of two cases. J Neurosurg 2003;98:617-20.
  • 21 Matsumura A, Oda M, Hozuki T, Imai T, Shimohama S. Dural arteriovenous fistula in a case of dementia with bithalamic MR lesions. Neurology 2008;71:1553.
  • 22 Racine CA, Lawton MT, Hetts SW, Josephson SA. Neuropyschological profile of reversible cognitive impairment in a patient with a dural arteriovenous fistula. Neurocase 2008;14:231-8.
  • 23 Wilson M, Enevoldson P, Menezes B. Intracranial dural arterio-venous fistula. Pract Neurol 2008;8:362-9.
  • 24 Yamamoto T, Watanabe M, Miura A, Hirahara T, Hirano T, Uchino M. A case of dural arteriovenous fistula associated with bilateral thalamic lesions. Rinsho Shinkeigaku 2010;50:718-24.
  • 25 Santillan A, Safdieh JE, Gobin YP, Patsalides A. Neurological picture. Bilateral thalamic venous hypertension caused by a tentorial dural arteriovenous fistula: Endovascular treatment. J Neurol Neurosurg Psychiatry 2011;82:749-50.
  • 26 Geraldes R, Albuquerque L, Ferro JM, Sousa R, Sequeira P, Campos J. Rapidly progressive cognitive impairment, ataxia, and myoclonus: An unusual presentation of a dural arteriovenous fistula. J Stroke Cerebrovasc Dis 2012;21:619.e3-5.
  • 27 Morparia N, Miller G, Rabinstein A, Lanzino G, Kumar N. Cognitive decline and hypersomnolence: Thalamic manifestations of a tentorial dural arteriovenous fistula (dAVF). Neurocrit Care 2012;17:429-33.
  • 28 Iwasawa E, Ishibashi S, Miki K, Yoshino Y, Nemoto S, Mizusawa H. Teaching NeuroImages: Reversible cognitive impairment with bithalamic lesions caused by a dural arteriovenous fistula. Neurology 2013;81:e38-9.
  • 29 Borja MJ, Schaefer PW, Boulter DJ. Case of the season: Dural arteriovenous fistula mimicking a bithalamic neoplasm or viral encephalitis. Semin Roentgenol 2014;49:4-9.
  • 30 Honig A, Eliahou R, Eichel R, Shemesh AA, Ben-Hur T, Auriel E. Acute bithalamic infarct manifesting as sleep-like coma: A diagnostic challenge. J Clin Neurosci 2016;34:81-5.
  • 31 Hwang H, La YK, Baek MS, Baik K, Suh SH, Kim WJ. Dural arteriovenous fistula manifested as rapid progressive dementia successfully treated by endovascular embolization only. Neurointervention 2017;12:50-3.
  • 32 Colorado RA, Matiello M, Yang HS, Rabinov JD, Patel A, Hirsch JA, et al. Progressive neurological decline with deep bilateral imaging changes: A protean presentation of dural arteriovenous fistulae. Interv Neurol 2018;7:256-64.
  • 33 Cannizzaro D, Brinjikji W, Rammos S, Murad MH, Lanzino G. Changing clinical and therapeutic trends in tentorial dural arteriovenous fistulas: A systematic review. AJNR Am J Neuroradiol 2015;36:1905-11.
  • 34 Cognard C, Januel AC, Silva NA Jr, Tall P. Endovascular treatment of intracranial dural arteriovenous fistulas with cortical venous drainage: New management using Onyx. AJNR Am J Neuroradiol 2008;29:235-41.
  • 35 Lamin S, Chew HS, Chavda S, Thomas A, Piano M, Quilici L, et al. Embolization of intracranial dural arteriovenous fistulas using PHIL liquid embolic agent in 26 patients: A multicenter study. AJNR Am J Neuroradiol 2017;38:127-31.
  • 36 Stam J. Thrombosis of the cerebral veins and sinuses. N Engl J Med 2005;352:1791-8.