Biegaj E, Rutkowska-Zimirska J, Radzymińska-Maliszewska M, Zaremba A, Pniewski J
Department of Neurology, Czerniakowski Hospital, Warsaw, Poland.
Department of General and Oncological Surgery, Mazovian Specialist Hospital, Radom, Poland.
Folia Morphol (Warsz). 2019;78(4):879-882. doi: 10.5603/FM.a2019.0016. Epub 2019 Feb 28.
We present a case of patient with a rare vessel pathology - arteriovenous fistula (AVF) of superficial temporal artery and vein. The 56-year-old man was admitted to the Department of Neurology because of a headache in the right temporal region with concomitant buzzing sound in his right ear. The pain was present mainly in the evenings and was stronger when touching the temporal region. He denied having any head injury in the last few years. There were no signs of central nervous system involvement in the neurological examination. Within the right temporal area a subcutaneous mass with redness of the surrounding skin and with palpable and audible pulsatile thrill was observed. In computed tomography (CT) of the head no abnormalities were found. In duplex-Doppler ultrasound examination of carotid arteries the systolic blood velocity in the right external carotid artery was over two times higher than in the left one. Its flow profile was turbulent and low-resistant. In CT angiography (CTA) an AVF between superficial temporal artery and vein was revealed - it was located at the level of the right zygomatic arch. In both CTA and magnetic resonance angiography, no abnormal connections between extra- and intracranial vessels were found. The patient underwent surgery with good result - all the symptoms disappeared. AVFs of vessels of the scalp are rare and their aetiology is mainly traumatic or iatrogenic. By describing this case we wanted to draw attention to less frequent causes of headache.
我们报告一例患有罕见血管病变——颞浅动静脉瘘（AVF）的患者。一名56岁男性因右颞部头痛伴右耳嗡嗡声入住神经内科。疼痛主要出现在晚上，触摸颞部时更强烈。他否认过去几年有任何头部受伤史。神经系统检查未发现中枢神经系统受累迹象。在右颞部区域观察到一个皮下肿块，周围皮肤发红，可触及且可听到搏动性震颤。头部计算机断层扫描（CT）未发现异常。在颈动脉双功多普勒超声检查中，右颈外动脉的收缩期血流速度比左颈外动脉高出两倍多。其血流形态呈湍流且阻力低。在CT血管造影（CTA）中发现颞浅动静脉之间存在AVF——位于右颧弓水平。在CTA和磁共振血管造影中，均未发现颅外和颅内血管之间有异常连接。患者接受手术，效果良好——所有症状均消失。头皮血管的AVF很少见，其病因主要是创伤性或医源性的。通过描述此病例，我们希望引起对较少见头痛原因的关注。
