title: Epistaxis caused by a dural AV-fistula at the cribriform plate.
abstract: OBJECTIVE
  A dural arteriovenous fistula (DAVF) with cortical venous reflux (CVR) is a dangerous neurovascular entity. A DAVF at the cribriform plate is typically silent until its inevitable presentation with intracranial hemorrhage.
  
  
  METHODS
  A 67-year-old male presented with severe epistaxis. Following unsuccessful conventional measures and a surgical exploration, a catheter angiography showed a DAVF at the cribriform plate, with its nidus extending into the nasal cavity. The DAVF was treated via a small craniotomy.
  
  
  CONCLUSIONS
  In case of atypical or unexplained nosebleeds, the possibility of a DAVF or other neurovascular pathology should be excluded by MRI/MRA or catheter angiography.
authors.affiliation: Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: J Marc C
authors.initials: JM
authors.lastname: van Dijk
authors.forename: Astrid G W
authors.initials: AG
authors.lastname: Korsten-Meijer
authors.forename: Aryan
authors.initials: A
authors.lastname: Mazuri
mesh_terms: D000368:Aged; D020785:Central Nervous System Vascular Malformations / Q000150:complications* / Q000000981:diagnostic imaging* / Q000601:surgery; D003399:Craniotomy / Q000379:methods; D004636:Emergency Service, Hospital; D004844:Epistaxis / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D005004:Ethmoid Bone / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D011859:Radiography; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods
keywords: Dural AV-fistula; anterior fossa; cortical venous reflux; epistaxis