Isolated intraventricular hemorrhage due to dural arteriovenous fistula (dAVF) is extremely rare and has been reported only a few times in the literature. The pathophysiological cause of isolated intraventricular hemorrhage in these cases was hypothetically attributed to retrograde venous flow into subependymal vessels, although none of these cases demonstrated radiographic evidence of such reflux. We present the first case of a dAVF with radiographic evidence of severe cortical venous reflux into the subependymal venous network causing isolated intraventricular hemorrhage, thus lending proof for the underlying pathophysiology. Furthermore, ours is the first case of dAVF with isolated intraventricular hemorrhage that was successfully treated using multimodality transvenous and transarterial embolization techniques. In cases of high-grade dAVF, multimodality treatment may offer the greatest chance for success, and should be strongly considered for management.
- liquid embolic material
- arteriovenous fistula
- intraventricular hemorrhage
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Republished with permission from BMJ Case Reports Published 7 February 2018; doi: 10.1136/bcr-2017-013571
Contributors KA, CR: conception, design, analysis and interpretation of data. KA: drafting of the manuscript. KA, FAM, CR: critical revisions for important intellectual content. All authors read and approved the final manuscript.
Competing interests None declared.
Patient consent Obtained.
Ethics approval University of Pittsburgh Medical Center, Hamot Institutional Review Board.
Provenance and peer review Not commissioned; externally peer reviewed.