title: Dural carotid-cavernous fistula presenting with confusion and expressive aphasia.
abstract: We report a patient who presented with confusion and expressive aphasia at the onset of a cortical venous reflux (CVR) related to a known dural carotid-cavernous fistula (DCCF). CVR and venous congestion are rare findings in a DCCF, however, it is important to recognize these findings early to reduce the associated risks of venous hemorrhage and infarction. To our knowledge, no previous report has described an association of expressive aphasia with CVR from a DCCF. This patient highlights the potential for venous congestion secondary to CVR from a DCCF presenting with a constellation of symptoms, including confusion and expressive aphasia with corresponding MRI findings. Clinicians should consider a DCCF in the differential diagnosis of this clinical presentation, with corroborative imaging findings.
authors.affiliation: Department of Radiology, University of Michigan Hospitals, Ann Arbor, MI, USA.
authors.forename: Sean
authors.initials: S
authors.lastname: Woolen
authors.affiliation: Department of Neurosurgery, Room UH B1 D328, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA; Department of Radiology, University of Michigan Hospitals, Ann Arbor, MI, USA; Department of Otolaryngology, University of Michigan, Ann Arbor, MI, USA. Electronic address: gemmete@med.umich.edu.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Gemmete
authors.affiliation: Department of Neurosurgery, Room UH B1 D328, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA; Department of Radiology, University of Michigan Hospitals, Ann Arbor, MI, USA.
authors.forename: Aditya S
authors.initials: AS
authors.lastname: Pandey
authors.affiliation: Department of Neurosurgery, Room UH B1 D328, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA; Department of Radiology, University of Michigan Hospitals, Ann Arbor, MI, USA.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Chaudhary
mesh_terms: D000368:Aged; D001039:Aphasia, Broca / Q000209:etiology*; D020216:Carotid-Cavernous Sinus Fistula / Q000150:complications* / Q000175:diagnosis*; D003221:Confusion / Q000209:etiology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging
keywords: Cortical venous reflux; Dural carotid cavernous fistula; Expressive aphasia