Dural arteriovenous fistulas masquerading as dural sinus thrombosis

J Neurosurg. 2009 Mar;110(3):514-7. doi: 10.3171/2008.7.JNS08253.

Abstract

The authors report dural sinus thrombosis diagnosed in 2 patients based on noninvasive imaging results, which were revealed to be dural arteriovenous fistulas (DAVFs) diagnosed using digital subtraction (DS) angiography. The first patient was a 63-year-old man who presented with headaches. Magnetic resonance venography was performed and suggested dural sinus thrombosis of the left transverse sinus and jugular vein. He was administered warfarin anticoagulation therapy but then suffered multiple intracranial hemorrhages. A DS angiogram was requested for a possible dural sinus thrombectomy, but the DS angiogram revealed a DAVF. The patient underwent serial liquid embolization with complete obliteration of the DAVF. The second patient, an 11-year-old boy, also presented with headaches and was diagnosed with dural sinus thrombosis on MR imaging. A DS angiogram was also requested for a possible thrombectomy and revealed a DAVF. This patient underwent serial liquid embolization and eventual operative resection. These reports emphasize that different venous flow abnormalities can appear similar on noninvasive imaging and that proper diagnosis is critical to avoid contraindicated therapies.

Publication types

  • Case Reports

MeSH terms

  • Angiography, Digital Subtraction
  • Central Nervous System Vascular Malformations / diagnosis*
  • Central Nervous System Vascular Malformations / diagnostic imaging
  • Central Nervous System Vascular Malformations / therapy
  • Child
  • Diagnosis, Differential
  • Dura Mater / blood supply*
  • Embolization, Therapeutic
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Sinus Thrombosis, Intracranial / diagnosis*