Chang Chia-Wei, Hung Hung-Chang, Tsai Jiao-I, Lee Po-Chang, Hung Shih-Chang
Departments of Neurology.
Internal Medicine.
Neurologist. 2019 Jul;24(4):132-135. doi: 10.1097/NRL.0000000000000235.
The occurrence of dural arteriovenous fistula (DAVF) is rare. The clinical manifestation varies and depends on the location and venous drainage pattern. We present a case of a 57-year-old man with a left transverse sinus DAVF along with sigmoid thrombosis, cortical venous reflux, and congestion, that initially presented as parkinsonism. The patient was alert and fully oriented; however, decreased facial expressions were noted. His left forearm showed rigidity and bradykinesia, and it was difficult for the patient to smoothly perform rapid alternating movement testing. His complaints about hearing a rhythmic bruit above the left ear, particularly when lying down, alerted the physician of the presence of vascular lesions. Magnetic resonance imaging and angiography confirmed the diagnosis of DAVF. The patient received a combined surgical and endovascular approach to permanently block the fistula blood flow. The motion and movement of his left upper limb improved after fistula embolization. Images at the 1-month follow-up showed a decrease in the volume of tortuous vessels, and the fistula was completely occluded.
硬脑膜动静脉瘘（DAVF）的发生较为罕见。其临床表现各异，取决于病变位置和静脉引流模式。我们报告一例57岁男性患者，患有左侧横窦DAVF并伴有乙状窦血栓形成、皮质静脉反流和充血，最初表现为帕金森综合征。患者神志清醒，定向力正常；然而，面部表情减少。其左前臂出现僵硬和运动迟缓，患者难以顺利完成快速交替运动测试。他抱怨左耳上方听到有节奏的杂音，尤其是躺下时，这使医生警觉到血管病变的存在。磁共振成像和血管造影确诊为DAVF。患者接受了手术和血管内联合治疗以永久阻断瘘管血流。瘘管栓塞后，其左上肢的运动和活动能力有所改善。1个月随访时的影像显示迂曲血管体积减小，瘘管完全闭塞。
