title: Cavernous Sinus Dural Arteriovenous Fistula Patients Presenting With Headache as an Initial Symptom.
abstract: Cavernous sinus (CS) dural arteriovenous fistula (dAVF) patients presenting with only headache as an initial symptom are not common. Patients with CS-dAVF commonly present with symptoms related to their eyes. In all three patients, headache was the initial symptom. Other symptoms related to the eyes developed 1 - 7 months after headache. In one patient, headache was controlled by sumatriptan succinate, but not diclofenac sodium or loxoprofen sodium. In another patient, headache was controlled by loxoprofen sodium. In the third patient, headache was improved by stellate ganglion block. In all patients, magnetic resonance angiography (MRA) in the early stage of the clinical course showed abnormal blood flow in the CS. However, reflux to the superior ophthalmic vein (SOV) was not detected. As treatment, transarterial and transvenous embolizations were necessary for one patient, and transvenous embolization was performed for another patient with significant blood flow to the SOV and cortical veins. On the other hand, manual compression of the bilateral carotid arteries at the neck resulted in disappearance of the fistula in the third patient. In all patients, the symptoms improved after the disappearance of blood reflux to the CS. The refluxed blood to the CS might cause elevation of the CS pressure and stimulate the trigeminal nerve in the dural membrane, resulting in headache before developing reflux in an anterior direction. CS-dAVF could induce both migraine and common headache. In cases with blood reflux to the CS on magnetic resonance imaging and/or MRA even without eye symptoms, a differential diagnosis of CS-dAVF should be taken into consideration.
authors.affiliation: Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.
authors.forename: Motohiro
authors.initials: M
authors.lastname: Nomura
authors.affiliation: Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Mori
authors.affiliation: Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Tamase
authors.affiliation: Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Kamide
authors.affiliation: Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.
authors.forename: Syunsuke
authors.initials: S
authors.lastname: Seki
authors.affiliation: Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Iida
authors.affiliation: Department of Neurology, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Kawabata
authors.affiliation: Department of Neurology, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.
authors.forename: Tatsu
authors.initials: T
authors.lastname: Nakano
authors.affiliation: Department of Neurosurgery, Shima Neurosurgical and Orthopedic Clinic, Kawasaki, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shima
authors.affiliation: Department of Neurosurgery, Taguchi Neurosurgery Clinic, Yokohama, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Taguchi
keywords: Cavernous sinus; Dural arteriovenous fistula; Headache; Migraine