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An Isolated Unilateral Pontomedullary Lesion Due to An Intracranial Dural Arteriovenous Fistula Mimicking A Brain Tumor - Case and Review.
J Nippon Med Sch 2019; 86(1):48-54JN

Abstract

Intracranial dural arteriovenous fistula (DAVF) with perimedullary venous drainage may cause brainstem swelling and represent a diagnostic challenge. A 66-year-old man presented to the emergency room with recurrent vertigo, minimal truncal ataxia with a wide-based gait, and a slightly impaired tandem gait. Brain magnetic resonance imaging (MRI) revealed a hyperintense lesion in the left pontomedullary area on T2-weighted images (T2WIs) with partial gadolinium enhancement, but without increased signals on diffusion-weighted images. Abnormal serpentine flow void vessels surrounding the medulla and upper cervical spinal cord were initially overlooked but discovered later. An angiogram revealed DAVF with feeders from the right occipital artery and the meningeal branch of the right distal vertebral artery with drainage into the anterior medullary venous system and the perimedullary veins. The patient underwent a successful transarterial endovascular embolization and improved gradually. A brain MRI at 3-month follow-up revealed a residual hyperintense signal on the T2WIs in the left lower medulla. Six cases of patients exhibiting DAVF with isolated unilateral brainstem swelling from the literature were reviewed. Isolated unilateral brainstem swelling due to intracranial DAVF with perimedullary venous drainage is extremely rare and might mimic a tumor on MRI. Abnormal serpentine flow void vessels on the surface of the brainstem or spinal cord are crucial diagnostic clues.

Authors+Show Affiliations

Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital.Department of Radiology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation. School of Medicine, Tzu Chi University.Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital. School of Medicine, Tzu Chi University.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

30918157

Citation

Chen, Pei-Ya, et al. "An Isolated Unilateral Pontomedullary Lesion Due to an Intracranial Dural Arteriovenous Fistula Mimicking a Brain Tumor - Case and Review." Journal of Nippon Medical School = Nippon Ika Daigaku Zasshi, vol. 86, no. 1, 2019, pp. 48-54.
Chen PY, Juan YH, Lin SK. An Isolated Unilateral Pontomedullary Lesion Due to An Intracranial Dural Arteriovenous Fistula Mimicking A Brain Tumor - Case and Review. J Nippon Med Sch. 2019;86(1):48-54.
Chen, P. Y., Juan, Y. H., & Lin, S. K. (2019). An Isolated Unilateral Pontomedullary Lesion Due to An Intracranial Dural Arteriovenous Fistula Mimicking A Brain Tumor - Case and Review. Journal of Nippon Medical School = Nippon Ika Daigaku Zasshi, 86(1), pp. 48-54. doi:10.1272/jnms.JNMS.2019_86-9.
Chen PY, Juan YH, Lin SK. An Isolated Unilateral Pontomedullary Lesion Due to an Intracranial Dural Arteriovenous Fistula Mimicking a Brain Tumor - Case and Review. J Nippon Med Sch. 2019;86(1):48-54. PubMed PMID: 30918157.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - An Isolated Unilateral Pontomedullary Lesion Due to An Intracranial Dural Arteriovenous Fistula Mimicking A Brain Tumor - Case and Review. AU - Chen,Pei-Ya, AU - Juan,Yu-Hsiu, AU - Lin,Shinn-Kuang, PY - 2019/3/29/entrez PY - 2019/3/29/pubmed PY - 2019/4/25/medline KW - brainstem swelling KW - dural arteriovenous fistula KW - perimedullary venous drainage KW - venous congestion SP - 48 EP - 54 JF - Journal of Nippon Medical School = Nippon Ika Daigaku zasshi JO - J Nippon Med Sch VL - 86 IS - 1 N2 - Intracranial dural arteriovenous fistula (DAVF) with perimedullary venous drainage may cause brainstem swelling and represent a diagnostic challenge. A 66-year-old man presented to the emergency room with recurrent vertigo, minimal truncal ataxia with a wide-based gait, and a slightly impaired tandem gait. Brain magnetic resonance imaging (MRI) revealed a hyperintense lesion in the left pontomedullary area on T2-weighted images (T2WIs) with partial gadolinium enhancement, but without increased signals on diffusion-weighted images. Abnormal serpentine flow void vessels surrounding the medulla and upper cervical spinal cord were initially overlooked but discovered later. An angiogram revealed DAVF with feeders from the right occipital artery and the meningeal branch of the right distal vertebral artery with drainage into the anterior medullary venous system and the perimedullary veins. The patient underwent a successful transarterial endovascular embolization and improved gradually. A brain MRI at 3-month follow-up revealed a residual hyperintense signal on the T2WIs in the left lower medulla. Six cases of patients exhibiting DAVF with isolated unilateral brainstem swelling from the literature were reviewed. Isolated unilateral brainstem swelling due to intracranial DAVF with perimedullary venous drainage is extremely rare and might mimic a tumor on MRI. Abnormal serpentine flow void vessels on the surface of the brainstem or spinal cord are crucial diagnostic clues. SN - 1347-3409 UR - https://www.unboundmedicine.com/medline/citation/30918157/An_Isolated_Unilateral_Pontomedullary_Lesion_Due_to_An_Intracranial_Dural_Arteriovenous_Fistula_Mimicking_A_Brain_Tumor_-_Case_and_Review L2 - https://dx.doi.org/10.1272/jnms.JNMS.2019_86-9 DB - PRIME DP - Unbound Medicine ER -