Dementia resulting from dural arteriovenous fistulas: The pathologic findings of venous hypertensive encephalopathy

Robert W. Hurst, Linda J. Bagley, Steven Galetta, Guila Glosser, Andrew P. Lieberman, John Trojanowski, Grant Sinson, Mark Stecker, Eric Zager, Eric C. Raps, Eugene S. Flamm

Research output: Contribution to journalArticle

155 Citations (Scopus)

Abstract

PURPOSE: Dural arteriovenous fistulas (DAVFs) are acquired arteriovenous shunts located within the dura. The highly variable natural history and symptomatology of DAVFs range from subjective bruit to intracranial hemorrhage and are related to the lesion's pattern of venous drainage and its effect on the drainage of adjacent brain. We examined the prevalence and features of DAVFs in patients with progressive dementia or encephalopathy. METHODS: The records and radiologic studies of 40 consecutive patients with DAVFs treated at our institution were reviewed. RESULTS: Five (12.5%) of 40 consecutive patients with DAVFs had encephalopathy or dementia. In each patient, high flow through the arteriovenous shunt combined with venous outflow obstruction caused impairment of cerebral venous drainage. Hemodynamically, the result was widespread venous hypertension causing diffuse ischemia and progressive dysfunction of brain parenchyma. Results of CT or MR imaging revealed abnormalities in each patient, reflecting the impaired parenchymal venous drainage. Pathologic findings in one patient confirmed the mechanism of cerebral dysfunction as venous hypertension. The hemodynamic mechanism and resulting abnormality appeared identical to that seen in progressive chronic myelopathy resulting from a spinal DAVF (Foix- Alajouanine syndrome). Remission of cognitive symptoms occurred in each patient after embolization. CONCLUSION: Venous hypertensive encephalopathy resulting from a DAVF should be considered a potentially reversible cause of vascular dementia in patients with progressive cognitive deficits.

Original languageEnglish (US)
Pages (from-to)1267-1273
Number of pages7
JournalAmerican Journal of Neuroradiology
Volume19
Issue number7
StatePublished - 1998
Externally publishedYes

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Hypertensive Encephalopathy
Central Nervous System Vascular Malformations
Dementia
Drainage
Brain Diseases
Hypertension
Neurobehavioral Manifestations
Vascular Dementia
Intracranial Hemorrhages
Spinal Cord Diseases
Brain
Natural History
Ischemia
Hemodynamics

ASJC Scopus subject areas

  • Clinical Neurology
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Hurst, R. W., Bagley, L. J., Galetta, S., Glosser, G., Lieberman, A. P., Trojanowski, J., ... Flamm, E. S. (1998). Dementia resulting from dural arteriovenous fistulas: The pathologic findings of venous hypertensive encephalopathy. American Journal of Neuroradiology, 19(7), 1267-1273.

Dementia resulting from dural arteriovenous fistulas : The pathologic findings of venous hypertensive encephalopathy. / Hurst, Robert W.; Bagley, Linda J.; Galetta, Steven; Glosser, Guila; Lieberman, Andrew P.; Trojanowski, John; Sinson, Grant; Stecker, Mark; Zager, Eric; Raps, Eric C.; Flamm, Eugene S.

In: American Journal of Neuroradiology, Vol. 19, No. 7, 1998, p. 1267-1273.

Research output: Contribution to journalArticle

Hurst, RW, Bagley, LJ, Galetta, S, Glosser, G, Lieberman, AP, Trojanowski, J, Sinson, G, Stecker, M, Zager, E, Raps, EC & Flamm, ES 1998, 'Dementia resulting from dural arteriovenous fistulas: The pathologic findings of venous hypertensive encephalopathy', American Journal of Neuroradiology, vol. 19, no. 7, pp. 1267-1273.
Hurst RW, Bagley LJ, Galetta S, Glosser G, Lieberman AP, Trojanowski J et al. Dementia resulting from dural arteriovenous fistulas: The pathologic findings of venous hypertensive encephalopathy. American Journal of Neuroradiology. 1998;19(7):1267-1273.
Hurst, Robert W. ; Bagley, Linda J. ; Galetta, Steven ; Glosser, Guila ; Lieberman, Andrew P. ; Trojanowski, John ; Sinson, Grant ; Stecker, Mark ; Zager, Eric ; Raps, Eric C. ; Flamm, Eugene S. / Dementia resulting from dural arteriovenous fistulas : The pathologic findings of venous hypertensive encephalopathy. In: American Journal of Neuroradiology. 1998 ; Vol. 19, No. 7. pp. 1267-1273.
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T1 - Dementia resulting from dural arteriovenous fistulas

T2 - The pathologic findings of venous hypertensive encephalopathy

AU - Hurst, Robert W.

AU - Bagley, Linda J.

AU - Galetta, Steven

AU - Glosser, Guila

AU - Lieberman, Andrew P.

AU - Trojanowski, John

AU - Sinson, Grant

AU - Stecker, Mark

AU - Zager, Eric

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AU - Flamm, Eugene S.

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AB - PURPOSE: Dural arteriovenous fistulas (DAVFs) are acquired arteriovenous shunts located within the dura. The highly variable natural history and symptomatology of DAVFs range from subjective bruit to intracranial hemorrhage and are related to the lesion's pattern of venous drainage and its effect on the drainage of adjacent brain. We examined the prevalence and features of DAVFs in patients with progressive dementia or encephalopathy. METHODS: The records and radiologic studies of 40 consecutive patients with DAVFs treated at our institution were reviewed. RESULTS: Five (12.5%) of 40 consecutive patients with DAVFs had encephalopathy or dementia. In each patient, high flow through the arteriovenous shunt combined with venous outflow obstruction caused impairment of cerebral venous drainage. Hemodynamically, the result was widespread venous hypertension causing diffuse ischemia and progressive dysfunction of brain parenchyma. Results of CT or MR imaging revealed abnormalities in each patient, reflecting the impaired parenchymal venous drainage. Pathologic findings in one patient confirmed the mechanism of cerebral dysfunction as venous hypertension. The hemodynamic mechanism and resulting abnormality appeared identical to that seen in progressive chronic myelopathy resulting from a spinal DAVF (Foix- Alajouanine syndrome). Remission of cognitive symptoms occurred in each patient after embolization. CONCLUSION: Venous hypertensive encephalopathy resulting from a DAVF should be considered a potentially reversible cause of vascular dementia in patients with progressive cognitive deficits.

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