Mistake in diagnosis, Patient complains / malpractice, Rare disease
Chad J. Cooper, Sarmad Said, Angelica Nunez, Raphael Quansah, Sayeed Khalillullah, German T. Hernandez
Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, USA
Am J Case Rep 2013; 14:444-448
Background: A dural arteriovenous fistula (DAVF), is an abnormal direct connection (fistula) between a meningeal artery and a meningeal vein or dural venous sinus. The pathogenesis of DAVF still remains unclear. Sinus thrombosis, head trauma, chronic central nervous system, hypercoagulable state, surgery, and hormonal influence are the predisposing factors that initiate this disease. The symptoms experienced by the patient will depend on the location of the fistula.
Case Report: Thirty-two year old Hispanic male who presented one day after a rear ended motor vehicle collision (MVC) with a severe throbbing headache in the left parietal region, left eye redness but no retro-orbital pain and tinnitus in the left ear. He was initially misdiagnosed to have a carotid-cavernous fistula but upon cerebral angiogram was actually diagnosed with a dural arterio-venous fistula in the posterior fossa venous system followed by successful embolization of the fistula.
Conclusions: A cerebral angiography is the gold standard for detection and characterization of a DAVF and will distinguish it from a CCF. Endovascular surgery involves a catheter-based technique for embolization of the lumen of arteries feeding the DAVF, or directly into the vein draining the DAVF. It is very important to recognize the typical findings of patients presenting with a DAVF then quickly proceeding with a cerebral angiogram to determine the exact location of the fistula and the appropriate treatment plan. By diagnosing and treating a DAVF as early as possible, the associated fatal complications can be averted.
Keywords: Motor vehicle collison, trauma, endovascular embolization, dural arteriovenous fistula, Cerebral Angiography