Introduction Dural arteriovenous fistulas (DAVFs) are pathologic vascular connections that shunt dural arterial flow directly to dural venous drainage. DAVFs constitute 10–15% of all intracranial arteriovenous malformations and are most commonly located in transverse, sigmoid, and cavernous sinuses. Symptoms from DAVFs vary based on lesion location and correlate with their respective patterns of venous drainage. Common presenting symptoms include pulsatile tinnitus, chronic headache, vision difficulties, cranial nerve abnormalities, cerebellar symptoms, focal neurologic deficits, and seizures. Only a few isolated case reports describe syncope on presentation, all in combination with other symptoms. In this article, we report a rare case of DAVF causing recurrent syncope.
Methods A 29 year-old female presented with a 9-year history of progressive syncopal episodes exacerbated by positional changes, strenuous activity and emotional stressors.
Results The patient was referred to us after symptoms of dizziness and syncope persisted despite treatment by multiple cardiologists, endocrinologists, and psychiatrists. Symptoms occurred upon wakening and lasted for 2–3 hours before she was able to regain functionality. Furthermore, she found that her symptoms would remit if she was to lay in the Trendelenburg position immediately after symptom onset. Physical exam revealed no abnormalities. MRI of the brain showed no irregularities. MRA revealed abnormal serpiginous structures in the left jugular foramen which communicated with the ascending pharyngeal branch of the left external carotid artery. Cerebral angiogram disclosed a left jugular foramen dural AVF (Borden/Cognard type 1) supplied by the left ascending pharyngeal and left occipital arteries. There was no retrograde flow or cortical venous reflux. The DAVF was successfully managed by progressive endovascular embolization with coils and Onyx 34 via transvenous route. The final cerebral angiogram demonstrated complete obliteration of the fistula. On clinical follow-up evaluation, the patient had no further episodes of dizziness or syncope.
Conclusion We present an atypical case of DAVF in a patient presenting with recurrent syncope. Only 3 cases of DAVF causing syncope have been reported, all in combination with other neurologic symptoms. In comparison, we report a unique case of DAVF presenting solely with recurrent syncope, a previously undocumented finding in the literature. Our case adds to other reports of nonspecific DAVF presentations and highlights the importance of considering this etiology.
Disclosures D. Sheinberg: None. E. Luther: None. D. McCarthy: None. R. Starke: None.
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