Acute confusional syndrome from a dural arteriovenous fistula.
OBJECTIVE
We describe a case of an acute confusional state associated with a right parietal dural arteriovenous fistula.


METHODS
A 67-year-old man in his usual state of health experienced an acute confusion episode preceded by a valsalva maneuver. The episode lasted approximately 60 minutes. Afterward he was able to remember everything that occurred. A magnetic resonance imaging scan suggested a right parietal dural arteriovenous fistula, which was confirmed by angiography. A seizure was ruled out by clinical examination and an electroencephalogram.


METHODS
The patient underwent therapeutic embolization and surgical ligation of the fistula. Feeding vessels to the malformation were cauterized within the leaves of the falx, and the draining vein was clipped with a titanium aneurysm clip and divided. An intraoperative angiogram was then performed, which showed obliteration of the fistula. There was no demonstrable confusion or memory loss noted postoperatively.


CONCLUSIONS
We propose that venous hypertension from the dural arteriovenous fistula in combination with a valsalva maneuver caused ischemia in the right parietal lobe, eliciting a deficit in attention.
Lantz
Emily R
ER
Department of Neurology, Columbia University, College of Physicians & Surgeons, New York, New York 10032, USA.
Lavine
Sean D
SD
Festa
Joanne R
JR
Connolly
E Sander
ES
Wright
Clinton B
CB
Lazar
Ronald M
RM
D000368:Aged; D001164:Arteriovenous Fistula / Q000150:complications*; D020785:Central Nervous System Vascular Malformations / Q000628:therapy; D002533:Cerebral Angiography; D003221:Confusion / Q000209:etiology*; D004621:Embolization, Therapeutic / Q000379:methods; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D014057:Tomography, X-Ray Computed