Intracranial Varix of the Transverse-sigmoid Dural Arteriovenous Fistula Mimicking a Ruptured Middle Cerebral Artery Aneurysm: A Case Report

Overview

Journal Surg Neurol Int

Specialty Neurology

Date 2022 Apr 11

PMID 35399877

Authors

Kuniyuki Onuma

Kiyoyuki Yanaka

Atsushi Tsukada

Kazuhiro Nakamura

Yuji Matsumaru

Eiichi Ishikawa

Affiliations

Soon will be listed here.

Abstract

Background: Hemorrhagic stroke is caused by various vascular abnormalities, such as aneurysms, arteriovenous malformations, and dural arteriovenous fistulas (DAVF). Magnetic resonance angiography (MRA) and three-dimensional computed tomography angiography (3DCTA) are used as efficient initial diagnostic modalities in assessing the etiology of hemorrhagic stroke. We describe the unusual case of a false-positive aneurysm on MRA and 3DCTA.

Case Description: A 65-year-old nonhypertensive woman was brought to our hospital with a sudden onset of headache and left hemiparesis. She also had chemosis in the right eye. CT and magnetic resonance imaging showed an intracerebral hemorrhage in the right temporal lobe. MRA and 3DCTA showed a rounded mass suggestive of an aneurysm arising from the bifurcation of the middle cerebral artery (MCA) and also demonstrated an abnormal tortuous vessel contacting with a rounded mass. Digital subtraction angiography showed a transversesigmoid sinus DAVF with a varix in contact with the MCA bifurcation. Hematoma evacuation and venous drainage disconnection through the right frontotemporal craniotomy were performed.

Conclusion: This case is very instructive and clinicians should keep in mind that detailed neurological and radiological examinations are essential in obtaining an accurate diagnosis, especially if the bleeding source is similar in shape and location to common lesions (such as a cerebral aneurysm).

Citing Articles

A Systematic Review and Case Illustrations of Misdiagnosing Intracranial Aneurysms.

Konovalov A, Gadzhiagaev V, Artemyev A, Okishev D, Pilipenko Y, Grebenev F Cureus. 2024; 16(4):e59185.

PMID: 38807799 PMC: 11130603. DOI: 10.7759/cureus.59185.

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