Hernández-Díaz Zenaida Milagros, Llíbre-Guerra Juan Carlos, Arteche-Prior Marianela, de la Paz-Bermúdez Tania, Águila-Ruiz Angel Francisco, Figueroa-García Luisa María, de Los Ángeles Robinson-Agramonte María
Department of Neuroimagenology, International Center for Neurological Restoration, 25th Ave, Playa 15805, Havana, post code 11300, Cuba.
Department of Endovascular Therapy and Stroke Unit, Institute of Neurology and Neurosurgery, Calle 29 y Esquina D, Havana 10400, Cuba.
Behav Sci (Basel). 2019 Jun 14;9(6):63. doi: 10.3390/bs9060063.
Dural arteriovenous fistulas (DAVFs) represent 10-15% of intracranial arteriovenous malformations. Of these, only 12-29% cause intracranial hemorrhage. The presentation of DAVF as a subdural hematoma (SDH) and intraparenchymal hemorrhage (IPH) is infrequent; additionally, behavioral changes are not common among these patients. We report, for the first time in our country, the case of a 23-year-old man with no history of head injury, in which a brain computed tomography (CT) scan revealed SDH and IPH with behavioral disturbances. The angiotomography showed ecstatic venous vessels, indicating the presence of a DAVF, which was later confirmed by cerebral angiography. Endovascular therapy, which followed the clinical diagnosis, resulted in satisfactory evolution two years after treatment. A review of the literature concerning cases with DAVF and behavioral disturbances is presented. DAVF may lead to cognitive impairment, behavioral changes, and dementia as a result of diffuse white matter and thalamus modifications related to venous ischemia, and it should be considered as a reversible cause of vascular dementia.
硬脑膜动静脉瘘（DAVF）占颅内动静脉畸形的10% - 15%。其中，仅有12% - 29%会导致颅内出血。DAVF表现为硬膜下血肿（SDH）和脑实质内出血（IPH）的情况并不常见；此外，这些患者中行为改变也不常见。我们在国内首次报告了一例23岁无头部外伤史的男性病例，其脑部计算机断层扫描（CT）显示有SDH和IPH并伴有行为障碍。血管造影显示有扩张的静脉血管，提示存在DAVF，随后经脑血管造影得以证实。临床诊断后进行的血管内治疗在治疗两年后取得了满意的进展。本文对有关DAVF与行为障碍病例的文献进行了综述。DAVF可能由于与静脉缺血相关的弥漫性白质和丘脑改变而导致认知障碍、行为改变和痴呆，应被视为血管性痴呆的一个可逆转病因。
