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Abstract Details

Hemodynamic Alterations and Reversible Cervicomedullary Edema after Embolization of Cranial Dural Arteriovenous Fistula
Cerebrovascular Disease and Interventional Neurology
P13 - Poster Session 13 (5:30 PM-6:30 PM)
4-012
To discuss the alterations in cerebral hemodynamics following embolization of a Cranial Dural Arteriovenous Fistula (DAVF).
DAVFs are an acquired abnormal single connection between arterial and venous blood flow. Successful embolization disrupts these abnormal connections, but may result in hemodynamic changes that lead to the development of new neurologic symptoms.
Case report.
A 72-year old man developed acute onset severe headache, left-sided neck pain, and left arm and leg weakness following IR embolization of a DAVF. During the procedure, he was hypertensive, with a blood pressure reading of 200/94 mmHg. He received IV tissue plasminogen activator (tPA) for a suspected acute ischemic stroke with minimal improvement. Shortly after, he developed aphasia and brief staring spells; the repeat head CT showed new edema in the left temporal parietal region. MRI of the cervical spine showed marked edema in the cervicomedullary region without restricted diffusion. His systolic blood pressure goal was reduced with antihypertensive medication to less than 140mmHg with almost immediate improvement in his motor strength. Hyperbaric oxygen treatment was initiated with further improvement in his hemiparesis.
Venous hypertension and arterial cerebral hyperperfusion are two distinct but related processes that led to deterioration in our patient. The rapid restoration of blood flow following DAVF embolization resulted in cerebral hyperperfusion syndrome, as evidenced in our patient who developed transient severe headache, aphasia, and seizures. His left-sided neurological deficits are likely attributed to cervicomedullary edema related to venous hypertension. Both findings are supported by his rapid improvement following strict blood pressure control and hyperbaric oxygen therapy with positive results.
Authors/Disclosures
Jessica White, MD
PRESENTER 		Dr. White has nothing to disclose.
Steven Tversky, DO (Steven Tversky) No disclosure on file
No disclosure on file
Rajanandini Muralidharan, MD, FÂ鶹´«Ã½Ó³»­ (Winthrop Neuroscience) Dr. Muralidharan has nothing to disclose.