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J Korean Soc Emerg Med > Volume 15(4); 2004 > Article
Journal of The Korean Society of Emergency Medicine 2004;15(4): 294-299.
Case of Occipitoparietal Protrusion of a Dural Arteriovenous Fistula
Hyung Min Lee, Hoon Pyo Hong, Myung Chun Kim, Young Gwan Ko
Department of Emergency Medicine, College of Medicine, Kyung Hee University, Seoul, Korea. edkmc@chol.com
Arteriovenous fistulas are vascular abnormalities consisting of fistulous connections of arteries and veins without normal intervening capillary beds. Arteriovenous fistulas (AVFs) located within the dura mater make up about 15% of all intracranial vascular malformations. Frequent sites of involvement include the transverse and the sigmoid sinuses, followed by the cavernous sinus, anterior cranial base, and tentorium. The natural history of dural AVFs (DAVFs) is highly variable. Some patients have no symptoms or benign symptoms for many years. Clinical symptoms are a complex function of multiple factors, such as location, mode of venous drainage, and magnitude of flow, as well as host angiologic factors. Reversal of flow and venous hypertension in the leptomeningeal draining veins account for the majority of neurological manifestations. The most common nonhemorrhagic symptoms include pulsatile tinnitus and headache. Other manifestations include a global or a focal neurological deficit that may be a seizure, papilledema, hydrocephalus, dementia, cranial nerve palsies, and cervical myelopathy. Angoigraphy is the gold standard of diagnosis. CT or MRI is often normal. We report a case of occipitoparietal protrusion of DAVFs in a 43-year-old man that presented initially as a pulsatile mass in his occiput.
Key words: Dural arteriovenous fistula, Sagittal sinus, Occipital
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