Dural Arteriovenous Fistula-induced Thalamic Dementia: Report Of 4 Cases
Abstract
Nonhemorrhagic neurological deficits are underrecognized symptoms of intracranial dural arteriovenous fistulas (dAVFs) having cortical venous drainage. These symptoms are the consequence of cortical venous hypertension and portend a clinical course with increased risk of neurological morbidity and mortality. One rarely documented and easily misinterpreted type of nonhemorrhagic neurological deficit is progressive dementia, which can result from venous hypertension in the cortex or in bilateral thalami. The latter, which is due to dAVF drainage into the deep venous system, is the less common of these 2 dementia syndromes. Herein, the authors report 4 cases of dAVF with venous drainage into the vein of Galen causing bithalamic edema and rapidly progressive dementia. Two patients were treated successfully with endovascular embolization, and the other 2 patients were treated successfully with endovascular embolization followed by surgery. The radiographic abnormalities and presenting symptoms rapidly resolved after dAVF obliteration in all 4 cases. Detailed descriptions of these 4 cases are presented along with a critical review of 15 previously reported cases. In our analysis of these 19 published cases, the following were emphasized: 1) the clinical and radiographic differences between dAVF-induced thalamic versus cortical dementia syndromes; 2) the differential diagnosis and necessary radiographic workup for patients presenting with a rapidly progressive thalamic dementia syndrome; 3) the frequency at which delays in diagnosis occurred and potentially dangerous and avoidable diagnostic procedures were used; and 4) the rapidity and completeness of symptom resolution following dAVF treatment.
Recommended Citation
T. F. Holekamp and M. E. Mollman and R. K. Murphy and G. R. Kolar and N. M. Kramer and C. P. Derdeyn and C. J. Moran and R. J. Perrin and K. M. Rich and G. Lanzino and G. J. Zipfel, "Dural Arteriovenous Fistula-induced Thalamic Dementia: Report Of 4 Cases," Journal of Neurosurgery, vol. 124, no. 6, pp. 1752 - 1765, American Association of Neurological Surgeons, Jun 2016.
The definitive version is available at https://doi.org/10.3171/2015.5.JNS15473
Department(s)
Biological Sciences
Keywords and Phrases
Cortical venous hypertension; Dural arteriovenous fistula; Nonhemorrhagic neurological deficit; Thalamic dementia; Thalamic edema; Vascular disorders
International Standard Serial Number (ISSN)
1933-0693; 0022-3085
Document Type
Article - Journal
Document Version
Citation
File Type
text
Language(s)
English
Rights
© 2025 American Association of Neurological Sutgeons, All rights reserved.
Publication Date
01 Jun 2016
PubMed ID
26587655
