Ma Chen, Lu Qiaoli, Shi Wanchao, Su Zhiguo, Zhao Yujun, Li Chen, Liu Zhenlin
Department of Neurology, The Fifth Central Hospital of Tianjin, Tianjin 300450, P.R. China.
Department of Neurosurgery, The Fifth Central Hospital of Tianjin, Tianjin 300450, P.R. China.
Exp Ther Med. 2015 Feb;9(2):523-526. doi: 10.3892/etm.2014.2122. Epub 2014 Dec 9.
A dural arteriovenous fistula (DAVF) presenting with parkinsonism and dementia is rare; thus, is easily misdiagnosed. The present study reports the case of a 62-year-old male with mobility disabilities and a cognitive disorder. The initial symptoms were progressive symmetrical limb stiffness and weakness without significant limb tremor, and subsequently the appearance of progressive memory loss, behavioral abnormalities and a decline in the activities of daily living. Cranial magnetic resonance imaging (MRI) revealed an enlarged vascular shadow at the meninges of the left temporal lobe. In addition, digital subtraction angiography (DSA) revealed a DAVF in the left temporal region, fed by the bilateral middle meningeal arteries and meningeal branches of the vertebral artery, which were enlarged abnormally, with poor venous reflux to the superior sagittal sinus. The patient was treated with transarterial embolization therapy. Intraoperative angiography showed almost complete embolization of the DAVF. At day 3 following the surgery, the muscle tension of the bilateral limbs decreased significantly. After two weeks, the memory ability of the patient had recovered to the level prior to the onset, and the gait was stable. At one month post-surgery, the patient was able to take care of himself completely, and after three months, a stereotactic treatment was conducted for the residual fistula. At the one year follow-up, neurological examination revealed that the patient had recovered normally. In conclusion, progressive parkinsonism and dementia with an abnormal flow void shadow on cranial MRI films should be considered as a possible diagnosis of a DAVF. In these cases, DSA and endovascular treatment are recommended as soon as possible.
以帕金森症和痴呆为表现的硬脑膜动静脉瘘（DAVF）较为罕见，因此很容易被误诊。本研究报告了一例62岁男性患者，有行动障碍和认知障碍。初始症状为进行性对称性肢体僵硬和无力，无明显肢体震颤，随后出现进行性记忆力减退、行为异常及日常生活活动能力下降。头颅磁共振成像（MRI）显示左侧颞叶脑膜处血管影增粗。此外，数字减影血管造影（DSA）显示左侧颞叶区域存在DAVF，由双侧脑膜中动脉及椎动脉脑膜支供血，这些血管异常增粗，向上矢状窦的静脉回流不佳。患者接受了经动脉栓塞治疗。术中血管造影显示DAVF几乎完全栓塞。术后第3天，双侧肢体肌张力明显降低。两周后，患者记忆能力恢复到发病前水平，步态稳定。术后1个月，患者能够完全自理，3个月后对残余瘘管进行了立体定向治疗。随访1年时，神经学检查显示患者已正常恢复。总之，头颅MRI片上有异常血流空洞影且伴有进行性帕金森症和痴呆时，应考虑可能为DAVF。对于这些病例，建议尽早进行DSA和血管内治疗。
