Kagawa Yuya, Imahori Taichiro, Okino Reiichi, Harada Tomoaki, Yamamoto Daisuke, Miyake Shigeru, Sasayama Takashi
Department of Neurosurgery, Kitaharima Medical Center, Hyogo, Japan.
Department of Neurosurgery, Kobe University Graduate School of Medicine, Hyogo, Japan.
Radiol Case Rep. 2023 Sep 19;18(11):4218-4221. doi: 10.1016/j.radcr.2023.08.097. eCollection 2023 Nov.
Unilateral subcortical calcifications are unique radiographic findings indicating specific focal pathologies. When the lesion is accompanied by edema, cerebral neoplasm usually leads to a differential diagnosis. This report presents a case of unilateral subcortical calcification and edema that resulted in cerebral hemorrhage and a subsequent diagnosis of an aggressive dural arteriovenous fistula. A man in his 60s presented with left hemianopsia and a progressive headache for over 6 months. Initial computed tomography revealed unilateral subcortical calcification and cerebral edema in the right occipital lobe, raising the suspicion of oligodendroglioma. However, 10 days later, a cerebral hemorrhage occurred in the lesion. Magnetic resonance imaging revealed flow void clusters and dilatation of the bilateral external carotid arteries and cortical veins, indicating a dural arteriovenous fistula. Cerebral angiography confirmed the presence of a parasagittal dural arteriovenous fistula (Borden type III). The patient was successfully treated with trans-arterial embolization using Onyx. Thus, calcifications with edema are more commonly associated with cerebral neoplasms; however, in this case, they indicated the presence of a dural arteriovenous fistula with severe corticovenous reflux. The presented case highlights the importance of recognizing these imaging features in dural arteriovenous fistulas and raises awareness of the potential danger of early hemorrhage after diagnosis. Therefore, timely evaluation of cranial vessels is essential in cases of unilateral subcortical calcification and edema to facilitate the early detection and management of aggressive dural arteriovenous fistulas.
单侧皮质下钙化是一种独特的影像学表现，提示特定的局灶性病变。当病变伴有水肿时，脑肿瘤通常会成为鉴别诊断的对象。本报告介绍了一例单侧皮质下钙化和水肿导致脑出血的病例，随后诊断为侵袭性硬脑膜动静脉瘘。一名60多岁的男性出现左侧偏盲和进行性头痛超过6个月。最初的计算机断层扫描显示右侧枕叶单侧皮质下钙化和脑水肿，怀疑为少突胶质细胞瘤。然而，10天后，病变部位发生脑出血。磁共振成像显示血流空洞簇以及双侧颈外动脉和皮质静脉扩张，提示硬脑膜动静脉瘘。脑血管造影证实存在矢状旁硬脑膜动静脉瘘（Borden III型）。该患者使用Onyx通过动脉栓塞成功治疗。因此，钙化伴水肿更常见于脑肿瘤；然而，在本病例中，它们提示存在伴有严重皮质静脉反流的硬脑膜动静脉瘘。本病例强调了认识硬脑膜动静脉瘘这些影像学特征的重要性，并提高了对诊断后早期出血潜在危险的认识。因此，对于单侧皮质下钙化和水肿的病例，及时评估颅血管对于促进侵袭性硬脑膜动静脉瘘的早期发现和管理至关重要。
