Sudden severe chest pain: thoracic dural arteriovenous fistula aneurysm rupture with intracranial subarachnoid haemorrhage.
Spinal perimedullary arteriovenous fistula (AVF) or dural arteriovenous fistula (DAVF) presenting as intracranial subarachnoid haemorrhage (SAH) is uncommon. A total of 16 cases have been reported to date. A majority of the reports described cervical spinal DAVF, while two other case reports described intracranial SAH secondary to lumbar and thoracic DAVF, respectively. We report a 61-year-old Chinese man with intracranial SAH secondary to thoracic DAVF aneurysm, who presented with sudden, severe chest pain, initially suggestive of aortic dissection/acute myocardial infarction. However, a careful examination of the history and physical signs, followed by appropriate and timely investigations enabled effective treatment to be administered promptly with a good outcome. This serves to illustrate the importance of investigating the entire cerebrospinal system when neurological symptoms and clinical signs suggest extracranial primary pathology.
Tan
A K
AK
Department of Neurosurgery, Singapore General Hospital, Outram Road, Singapore 168752. tak136@pacific.net.sg
Dinesh
S K
SK
Lim
W E
WE
Ng
I H
IH
D000328:Adult; D017542:Aneurysm, Ruptured / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D020785:Central Nervous System Vascular Malformations / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D002637:Chest Pain / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D004621:Embolization, Therapeutic / Q000379:methods*; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D018810:Magnetic Resonance Angiography; D008297:Male; D035583:Rare Diseases; D018570:Risk Assessment; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D015718:Fibrin Tissue Adhesive