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Neurocase. 2008;14(3):231-8. doi: 10.1080/13554790802232677. Epub 2008 Jul 4.

Neuropyschological profile of reversible cognitive impairment in a patient with a dural arteriovenous fistula.

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  • 1Department of Neurology, University of California, San Francisco, CA 94143-0114, USA.

Abstract

OBJECTIVE AND IMPORTANCE:

Patients with dural arteriovenous fistulas (dAVFs) may present with cognitive impairment secondary to venous hypertension or ischemia.

CLINICAL PRESENTATION:

We present a patient with a dAVF supplied by the posterior meningeal artery who presented with severe encephalopathy and imaging consistent with bilateral thalamic ischemia.

RESULTS:

Detailed pre-operative neuropsychological testing documented severe cognitive deficits across multiple domains, localizing diffusely in the cerebral cortex, beyond that which would be expected from purely thalamic involvement. Approximately 2 months following a combined endovascular and surgical repair, repeat neuropsychological testing documented a dramatic improvement in cognitive symptoms while MRI abnormalities in the thalami resolved.

CONCLUSION:

Detailed neuropsychological testing may be useful in patients presenting with dAVFs in order to identify cognitive impairment, which may be out of proportion to imaging findings. Recognition of dAVF-associated cognitive impairment may lead to more aggressive, timely treatment in patients with otherwise lower-risk lesions. This detailed testing can also provide a baseline in order to document cognitive recovery after fistula repair.

PMID:
18609005
DOI:
10.1080/13554790802232677
[PubMed - indexed for MEDLINE]
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