Abstract

A concomitant focal seizure with left hemipaeresis and exophthalmos in the context of an aggressive cavernous dural arteriovenous fistula (dAVF) is a variable neurological presentation. Here, we report a 73 years old female who presented with a 5-months history of progressive painless exophthalmos with conjunctival chemosis of right eye without any visual impairment. But now she had admitted to the hospital due to new onset of focal seizures with mild left hemipaeresis. Emergency MDCT scan brain showed suspected small malignant dural ateriovenous fistula of right sphenoparietal sinus with cerebral venous congestion and tiny hemorrhagic venous infarction at right operculum and right exophthalmos. Cerebral angiography demonstrated right cavernous dAVF fed by branches from the right ascending pharyngeal artery and right middle meningeal artery, right accessory meningeal artery, bilateral arteries of foramen rotendum, dural branch of left vertebral artery with drainage to the right superior ophthalmic vein, right sphenoparietal sinus and right frontal cortical vein which was consistent with Cognard Type IIb dAVF. Successful transvenous embolization of the right cavernous via the right inferior petrosal sinus was done by using fibre coils and NBCA. Post- embolization control angiogram showed complete obliteration of right cavernous dAVF feeding vessels. Subsequent clinical follow up revealed that she had dramatic improvement of proptosis, chemosis and neurological symptoms along with cessation of seizures.

Keywords: Dural Arteriovenous Fistula; Exophthalmos; Hemipaeresis; Seizures; Endovascular Treatment

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Citation

Citation: Aminur Rahman, et al. “Dural Arteriovenous Fistula Presenting with Exophthalmos, Hemiparesis and Seizures: Resolution after Endovascular Treatment - Case Report". Acta Scientific Medical Sciences 4.9 (2020): 74-79.

Copyright

Copyright: © 2020 Aminur Rahman, et al This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.