Dementia resulting from dural arteriovenous fistulas: the pathologic findings of venous hypertensive encephalopathy.
OBJECTIVE
Dural arteriovenous fistulas (DAVFs) are acquired arteriovenous shunts located within the dura. The highly variable natural history and symptomatology of DAVFs range from subjective bruit to intracranial hemorrhage and are related to the lesion's pattern of venous drainage and its effect on the drainage of adjacent brain. We examined the prevalence and features of DAVFs in patients with progressive dementia or encephalopathy.


METHODS
The records and radiologic studies of 40 consecutive patients with DAVFs treated at our institution were reviewed.


RESULTS
Five (12.5%) of 40 consecutive patients with DAVFs had encephalopathy or dementia. In each patient, high flow through the arteriovenous shunt combined with venous outflow obstruction caused impairment of cerebral venous drainage. Hemodynamically, the result was widespread venous hypertension causing diffuse ischemia and progressive dysfunction of brain parenchyma. Results of CT or MR imaging revealed abnormalities in each patient, reflecting the impaired parenchymal venous drainage. Pathologic findings in one patient confirmed the mechanism of cerebral dysfunction as venous hypertension. The hemodynamic mechanism and resulting abnormality appeared identical to that seen in progressive chronic myelopathy resulting from a spinal DAVF (Foix-Alajouanine syndrome). Remission of cognitive symptoms occurred in each patient after embolization.


CONCLUSIONS
Venous hypertensive encephalopathy resulting from a DAVF should be considered a potentially reversible cause of vascular dementia in patients with progressive cognitive deficits.
Hurst
R W
RW
Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104, USA.
Bagley
L J
LJ
Galetta
S
S
Glosser
G
G
Lieberman
A P
AP
Trojanowski
J
J
Sinson
G
G
Stecker
M
M
Zager
E
E
Raps
E C
EC
Flamm
E S
ES
D000368:Aged; D001164:Arteriovenous Fistula / Q000150:complications* / Q000473:pathology / Q000628:therapy; D001927:Brain Diseases / Q000209:etiology / Q000473:pathology; D002545:Brain Ischemia / Q000209:etiology; D002543:Cerebral Hemorrhage / Q000209:etiology; D002550:Cerebral Veins / Q000473:pathology; D002560:Cerebrovascular Circulation; D003072:Cognition Disorders / Q000628:therapy; D015140:Dementia, Vascular / Q000209:etiology* / Q000473:pathology; D004388:Dura Mater / Q000098:blood supply*; D004621:Embolization, Therapeutic; D006439:Hemodynamics; D006801:Humans; D006973:Hypertension / Q000150:complications; D002538:Intracranial Arteriovenous Malformations / Q000150:complications* / Q000473:pathology / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012039:Regional Blood Flow; D012189:Retrospective Studies; D013118:Spinal Cord Diseases / Q000209:etiology; D014057:Tomography, X-Ray Computed