A Case of Dural Arteriovenous Fistula Presenting with Dizziness

Abstract

　Herein, we report the case of a 76-year-old woman with dural arteriovenous fistula (dAVF) who presented with dizziness. At her first visit to our otolaryngology outpatient clinic, she complained of dizziness and staggering while walking, but there were no obvious symptoms of cranial nerve involvement. She presented with leftward nystagmus under an infrared CCD camera and unconscious left-dominant sensorineural hearing loss.

　Based on the above, she was diagnosed as having probable acute impairment of the inner ear and treated with prednisolone, and anti-motion sickness and antiemetic medications. CT and MRI revealed cerebellar edema and cortical venous ectasia. We referred the patient to the Department of Neurosurgery, and cerebral angiography revealed transverse-sigmoid sinus dAVF, type II according to Borden's classification, fed mainly by the left occipital artery.

　We performed embolization of the left occipital artery 14 days after the patient first visited us. Blood flow through the left occipital artery decreased, but there was only scarce improvement of the cerebellar edema caused by collateral vascular flow. We referred her to a university hospital. 42 days after her first visit, the patient underwent embolization was performed against reflux to the right superior petrosal sinus from residual shunts of the left middle meningeal artery, left ascending pharyngeal artery and left tentorial artery by way of the left sigmoid sinus at the university hospital. The cerebellar edema improved, and the patient was discharged 58 days after the first visit.

　Although this patient never complained of tinnitus, many cases of dAVF complain of pulsatile tinnitus. In cases of type I (Borden's classification) dAVF who do not have cortical venous reflux, the condition is usually not severe, whereas dAVF with cortical venous reflux can be fatal. Careful attention should be paid to the presence of pulsatile tinnitus.