A Case of Cavernous Sinus Dural Arteriovenous Fistulas causing Hemorrhage shortly after Eye Symptoms Appears

Abstract

We report a case of cavernous sinus dural arteriovenous fistulas (CS-dAVFs) presenting with intracranial hemorrhage a few days after eye symptoms appeared. An 82-year-old woman visited our hospital for left exophthalmos and chemosis. MRI showed CS-dAVFs with retrograde leptomeningeal venous drainage (RLVD). We therefore planned early treatment, however, before surgery, her consciousness deteriorated gradually with right hemiparesis and aphasia. Her CT scan revealed intracerebral hemorrhage involving the left putamen and venous infarction extending to the inferior part of the left frontal lobe and temporal lobe, and the insular cortex. Cerebral angiography showed CS-dAVFs with RLVD not only in the superficial middle cerebral vein but also in the deep middle cerebral vein. Transvenous embolization was performed using mechanically detachable coils. After embolization, the patient's dAVFs with RLVD disappeared and her symptoms improved within a few months. We think that advanced age is one of the risk factors for CS-dAVFs hemorrhages. Therefore, elderly patients with CS-dAVFs with RLVD should be treated as soon as possible. Moreover, Volume subtracted 3D-CT angiography is very effective for understanding the underling mechanism of the hemorrhage.