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CASE REPORT
Catch me if you can: disappearing and reappearing posterior fossa dural arteriovenous malformation
  1. Guilherme J Agnoletto1,
  2. Jason M Hoover2,
  3. Andre Monteiro1 and
  4. Ricardo A Hanel1
  1. 1 Baptist Neurological Institute, Lyerly Neurosurgery, Jacksonville, Florida, USA
  2. 2 Texas Brain and Spine Institute, Bryan, Texas, USA
  1. Correspondence to Dr Ricardo A Hanel, rhanel{at}lyerlyneuro.com

Abstract

We report an unusual case of a dural arteriovenous fistula (dAVF) presenting as acute neck pain and quadripareis in a 55-year-old previously healthy man. Imaging was suspicious for cervicomedullary venous thrombosis and angiography failed to show evidence of arteriovenous malformation or dAVF. The patient was started on warfarin for a presumed cervicomedullary venous thrombosis and there was a significant clinical improvement. However, 3 weeks later, the symptoms recurred and repeat angiography revealed a dAVF fed by a posterior branch of the left middle meningeal artery draining into the posterior fossa vein. We postulated that warfarin caused recanalisation of the previously thrombosed venous pouch allowing for angiographic discovery and treatment of the dAVF. The dAVF was embolised with onyx resulting in the complete obliteration of the dAVF and symptomatic improvement. Although rare, some dAVF can be concealed or disappear on angiography due to thrombosis of the draining vein and warfarin can lead to recanalisation.

  • neuroimaging
  • headache (including migraines)
  • stroke
  • interventional radiology
  • neurosurgery
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Footnotes

  • Contributors GJA and RAH: study concept and design. GJA, RAH, JMH and AM: acquisition of the data, analysis and interpretation of the data, and drafting of the manuscript. GJA and RAH: critical revision of the manuscript for important intellectual content. JMH and AM: administrative, technical, and material support. RAH: study supervision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests RAH is a consultant for Covidien, Stryker, Codman and Microvention. All other authors have nothing to disclose.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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