title: Medullary venous hypertension secondary to a petrous apex dural arteriovenous fistula: a case report.
abstract: BACKGROUND
  Dural arteriovenous fistulae (dAVF) are common intracranial vascular lesions typically becoming symptomatic with cortical venous hypertension and possible hemorrhage. Here, we present a case illustration of a petrous apex dAVF with marked medullary venous hypertension and a unique clinical presentation.
  
  
  METHODS
  Case report.
  
  
  RESULTS
  A 72-year-old female, whose clinical progression was significant for altered mental status and progressive weakness, presented with diplopia, right leg paresis, and ataxia. Magnetic resonance imaging revealed edema involving the medulla. On digital subtraction cerebral angiogram, the patient was found to have a petrous apex dAVF, Cognard type IV. Following treatment with Onyx embolization, her symptoms rapidly improved, with complete resolution of diplopia and drastic improvement of her ataxia.
  
  
  CONCLUSIONS
  The importance of this case is in the presentation and deterioration of the clinical exam, resembling an acute ischemic event. Further, this case illustrates that dAVF may cause venous hypertension with rapid onset of focal neurologic symptoms not exclusive to cortical locations.
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, Minn., USA.
authors.forename: Meghan
authors.initials: M
authors.lastname: Murphy
authors.forename: Jamie J
authors.initials: JJ
authors.lastname: Van Gompel