Saito Kazuyuki, Hino Taro, Fujita Satoshi, Hayashi Morito, Kubodera Takayuki, Wada Yoshiaki
Department of Neurology, Nissan Tamagawa Hospital.
Nissan Tamagawa Hospital Rehabilitation Center.
Rinsho Shinkeigaku. 2019 Feb 23;59(2):93-97. doi: 10.5692/clinicalneurol.cn-001200. Epub 2019 Jan 31.
We herein report a 67-year-old female who presented with progressive dementia and disturbance of consciousness. Brain CT showed multiple subcortical calcifications with edema. Enhanced CT showed multiple abnormal vessels in the left hemisphere. Electroencephalography indicated diffuse spike and slow wave complex, so non-convulsive status epilepticus was diagnosed. Cerebral angiography revealed several feeder arteries with retrograde leptomeningeal venous drainage. We diagnosed her with Borden type III cerebral dural arteriovenous fistulas. Trans-arterial embolization with n-butyl-2-cyanoacrylate was performed, and she has experienced no epileptic attacks for at least ten months. Calcification changes are sometimes seen in Borden type II dural arteriovenous fistulas but not in aggressive types, such as Borden type III. It is important to suspect dural arteriovenous fistulas when we encounter patients with progressive dementia or/and epilepsy with cerebral calcification lesions, as this may be a treatable disease condition.
我们在此报告一名67岁女性,她出现进行性痴呆和意识障碍。脑部CT显示多个皮质下钙化伴水肿。增强CT显示左半球有多个异常血管。脑电图显示弥漫性棘慢复合波,因此诊断为非惊厥性癫痫持续状态。脑血管造影显示有几条供血动脉伴软脑膜静脉逆行引流。我们诊断她为博登III型硬脑膜动静脉瘘。采用正丁基-2-氰基丙烯酸酯进行经动脉栓塞治疗,她至少十个月未再发生癫痫发作。钙化改变有时可见于博登II型硬脑膜动静脉瘘,但在侵袭性类型如博登III型中则不会出现。当我们遇到患有进行性痴呆或/和伴有脑钙化病变的癫痫患者时,怀疑硬脑膜动静脉瘘很重要,因为这可能是一种可治疗的疾病状态。