title: Foramen magnum dural arteriovenous fistula presenting with epilepsy.
abstract: Intracranial dural arteriovenous fistulas (dAVFs) with perimedullary drainage represent a rare subtype of intracranial dAVF. Patients usually experience slowly progressive ascending myelopathy and/or lower brainstem signs. We present a case of foramen magnum dural arteriovenous fistula with an atypical clinical presentation. The patient initially presented with a generalised tonic-clonic seizure and no signs of myelopathy, followed one month later by rapidly progressive tetraplegia and respiratory insufficiency. The venous drainage of the fistula was directed both to the left temporal lobe and to the perimedullary veins (type III + V), causing venous congestion and oedema in these areas and explaining this unusual combination of symptoms. Rotational angiography and overlays with magnetic resonance imaging volumes were helpful in delineating the complex anatomy of the fistula. After endovascular embolisation, there was complete remission of venous congestion on imaging and significant clinical improvement. To our knowledge, this is the first report of a craniocervical junction fistula presenting with epilepsy.
authors.affiliation: Interventional Neuroradiology Department, Strasbourg University Hospitals, France Institut Hospitalo-Universitaire, Strasbourg, France Neurology Department, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania pop.raoul@gmail.com.
authors.forename: Raoul
authors.initials: R
authors.lastname: Pop
authors.affiliation: Interventional Neuroradiology Department, Strasbourg University Hospitals, France.
authors.forename: Monica
authors.initials: M
authors.lastname: Manisor
authors.affiliation: Interventional Neuroradiology Department, Strasbourg University Hospitals, France.
authors.forename: Ziad
authors.initials: Z
authors.lastname: Aloraini
authors.affiliation: Neurosurgery Department, Strasbourg University Hospitals, France.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Chibarro
authors.affiliation: Neurosurgery Department, Strasbourg University Hospitals, France.
authors.forename: Francois
authors.initials: F
authors.lastname: Proust
authors.affiliation: Vascular Neurology Department, Strasbourg University Hospitals, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Quenardelle
authors.affiliation: Neurosurgery Department, Strasbourg University Hospitals, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Wolff
authors.affiliation: Interventional Neuroradiology Department, Strasbourg University Hospitals, France.
authors.forename: Rémy
authors.initials: R
authors.lastname: Beaujeux
mesh_terms: D000328:Adult; D020785:Central Nervous System Vascular Malformations / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy*; D002533:Cerebral Angiography; D003937:Diagnosis, Differential; D018450:Disease Progression; D004338:Drug Combinations; D004569:Electroencephalography; D004621:Embolization, Therapeutic / Q000379:methods*; D004827:Epilepsy / Q000000981:diagnostic imaging / Q000209:etiology*; D005539:Foramen Magnum; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011145:Polyvinyls / Q000627:therapeutic use; D013635:Tantalum / Q000627:therapeutic use
chemical_list: D004338:Drug Combinations; C558446:Onyx 18; D011145:Polyvinyls; D013635:Tantalum
keywords: Dural arteriovenous fistula; epilepsy; myelopathy; perimedullary drainage