We report a patient with a petrosal arterio-venous dural fistula draining into the ponto-mesencephalic and medullary venous systems presenting with edema of the brain stem and complete reversal of magnetic resonance imaging (MRI) abnormalities after combined endovascular and surgical treatments. The venous anatomy of the posterior fossa and the significance of the venous involvement as the cause of clinical symptoms and imaging abnormalities in cerebro-medullary vascular lesions are discussed.
DabusGBernsteinRAHurleyMC. Reversal of diffusion restriction after embolization of dural arteriovenous fistula: Case report. Neurosurgery2010; 67: E1147–E1151. discussion E1151.
2.
SarmaDFarbRIMikulisDJ. Reversal of restricted diffusion in cerebral venous thrombosis: Case report. Neuroradiology2004; 46: 118–121.
3.
DucreuxDOppenheimCVandammeX. Diffusion-weighted imaging patterns of brain damage associated with cerebral venous thrombosis. AJNR Am J Neuroradiol2001; 22: 261–268.
4.
BordenJAWuJKShucartWA. A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment. J Neurosurg1995; 82: 166–179.
5.
CognardCGobinYPPierotL. Cerebral dural arteriovenous fistulas: Clinical and angiographic correlation with a revised classification of venous drainage. Radiology1995; 194: 671–680.
6.
FujiiHNaganoYHosomiN. Dural arteriovenous fistula presenting with progressive dementia and parkinsonism. Br Med J Case Rep. Epub ahead of print 2 June 2014. DOI: 10.1136/bcr-2014-203921.
7.
HurstRWBagleyLJGalettaS. Dementia resulting from dural arteriovenous fistulas: he pathologic findings of venous hypertensive encephalopathy. AJNR Am J Neuroradiol1998; 19: 1267–1273.
8.
KaiYItoKKinjoT. Reversibility of cognitive disorder after treatment of dural arteriovenous fistulae. Neuroradiology2009; 51: 731–739.
9.
FilippidisAKapsalakiEPatramaniG. Cerebral venous sinus thrombosis: Review of the demographics, pathophysiology, current diagnosis, and treatment. Neurosurg Focus2009; 27: E3.
10.
SimardJMKentTAChenM. Brain oedema in focal ischaemia: Molecular pathophysiology and theoretical implications. Lancet Neurol2007; 6: 258–268.
11.
MakkatSStadnikTPeetersE. Pathogenesis of venous stroke: Evaluation with diffusion- and perfusion-weighted MRI. J Stroke Cerebrovasc Dis2003; 12: 132–136.
12.
ForbesKPPipeJGHeisermanJE. Evidence for cytotoxic edema in the pathogenesis of cerebral venous infarction. AJNR Am J Neuroradiol2001; 22: 450–455.
13.
FrerichsKUDeckertMKempskiO. Cerebral sinus and venous thrombosis in rats induces long-term deficits in brain function and morphology: Evidence for a cytotoxic genesis. J Cereb Blood Flow Metab1994; 14: 289–300.
14.
SakamotoSOhbaSShibukawaM. Course of apparent diffusion coefficient values in cerebral edema of dural arteriovenous fistula before and after treatment. Clin Neurol Neurosurg2008; 110: 400–403.
15.
SatoKShimizuHFujimuraM. Compromise of brain tissue caused by cortical venous reflux of intracranial dural arteriovenous fistulas: Assessment with diffusion-weighted magnetic resonance imaging. Stroke2011; 42: 998–1003.
16.
HudakAMPengLMarquez de la PlataC. Cytotoxic and vasogenic cerebral oedema in traumatic brain injury: Assessment with FLAIR and DWI imaging. Brain Inj2014; 28: 1602–1609.
17.
KaiYHamadaJIMoriokaM. Brain stem venous congestion due to dural arteriovenous fistulas of the cavernous sinus. Acta Neurochir (Wien)2004; 146: 1107–1111. discussion 1111–1112.
18.
MiyagishimaTHaraTInoueM. Pontine venous congestion due to dural arteriovenous fistula of the cavernous sinus: Case report and review of the literature. Surg Neurol Int2012; 3: 53.
19.
Stiebel-KalishHSettonANimiiY. Cavernous sinus dural arteriovenous malformations: Patterns of venous drainage are related to clinical signs and symptoms. Ophthalmology2002; 109: 1685–1691.
20.
TakahashiSTomuraNWataraiJ. Dural arteriovenous fistula of the cavernous sinus with venous congestion of the brain stem: Report of two cases. AJNR Am J Neuroradiol1999; 20: 886–888.
21.
UchinoAKatoAKurodaY. Pontine venous congestion caused by dural carotid-cavernous fistula: Report of two cases. Eur Radiol1997; 7: 405–408.
22.
IshiharaHIshiharaSOkawaraM. Two cases of a dural arteriovenous fistula mimicking a brain tumor. Interv Neuroradiol2009; 15: 77–80.
23.
LiJEzuraMTakahashiA. Intracranial dural arteriovenous fistula with venous reflux to the brainstem and spinal cord mimicking brainstem infarction–case report. Neurol Med Chir (Tokyo)2004; 44: 24–28.
24.
MathonBGallasSTuillierT. Intracranial dural arteriovenous fistula with perimedullary venous drainage: Anatomical, clinical and therapeutic considerations about one case, and review of the literature. Neurochirurgie2013; 59: 133–137.
25.
RicolfiFManelfeCMederJF. Intracranial dural arteriovenous fistulae with perimedullary venous drainage. Anatomical, clinical and therapeutic considerations. Neuroradiology1999; 41: 803–812.
26.
BaltsaviasGParthasarathiVAydinE. Cranial dural arteriovenous shunts. Part 1. Anatomy and embryology of the bridging and emissary veins. Neurosurg Rev2015; 38: 253–264.
27.
MatsushimaTRhotonALJrde OliveiraE. Microsurgical anatomy of the veins of the posterior fossa. J Neurosurg1983; 59: 63–105.
28.
KiyosueHTanoueSSagaraY. The anterior medullary-anterior pontomesencephalic venous system and its bridging veins communicating to the dural sinuses: Normal anatomy. Neuroradiology2008; 50: 1013–1023.
29.
KaiYHamadaJMoriokaM. Arteriovenous fistulas at the cervicomedullary junction presenting with subarachnoid hemorrhage: Six case reports with special reference to the angiographic pattern of venous drainage. AJNR Am J Neuroradiol2005; 26: 1949–1954.
30.
Van DijkJMTerBruggeKGWillinskyRA. Selective disconnection of cortical venous reflux as treatment for cranial dural arteriovenous fistulas. J Neurosurg2004; 101: 31–35.
31.
MitsuhashiYAurboonyawatTPereiraVM. Dural arteriovenous fistulas draining into the petrosal vein or bridging vein of the medulla: possible homologs of spinal dural arteriovenous fistulas. Clinical article. J Neurosurg2009; 111: 889–899.
