Iatrogenic arteriovenous fistula presenting as a recurrent subdural hematoma. Case report.
An unusual case of an iatrogenic dural arteriovenous fistula is reported. The patient presented with a history of progressive generalized headache over a period of 3 to 4 weeks. Computerized tomography demonstrated a chronic subdural hematoma that was successfully evacuated by burr-hole drainage. The patient's postoperative course was complicated by recurrent acute subdural hematomas at the drainage site. Coagulation studies were unremarkable. Selective external carotid angiography demonstrated a small dural arteriovenous fistula adjacent to the burr hole used for the initial operative procedure. Extension of the bone flap and coagulation of the fistula resulted in a good outcome. In the patient with recurrent acute subdural hematoma, the possibility of a vascular malformation must be considered. Selective internal and external carotid angiography is key to the correct diagnosis.
Pappas
C T
CT
Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona.
Zabramski
J M
JM
Shetter
A G
AG
D001164:Arteriovenous Fistula / Q000150:complications / Q000175:diagnosis* / Q000209:etiology; D003937:Diagnosis, Differential; D004322:Drainage / Q000009:adverse effects; D004388:Dura Mater / Q000098:blood supply; D005260:Female; D006408:Hematoma, Subdural / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D012008:Recurrence