A patient with multiple dural arteriovenous fistulas accompanied by status epilepticus and associated with reversible marked abnormalities on MR imaging

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  • 痙攣重積で発症し，ＭＲ画像上広範な可逆性病変を認めた多発性硬膜動静脈瘻の１例

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Abstract

Although reversible diffuse white matter signal changes caused by dural arteriovenous fistula (DAVF) are well known, studies on changes in the cortical gray matter have not been described. This report deals with a case of multiple DAVF associated with widespread but reversible high-intensity areas in the cortical gray and white matter detected on MR imaging and featuring status epilepticus. A 62-year-old man with a history of previous cerebral infarction and convulsions presented in a confused state. One day after the onset of confusion, he developed status epilepticus, while mild right hemiparesis was observed. T2 weighted MR imaging revealed a diffuse and widespread hyperintensity area in the left cortical gray matter. Fluid-attenuated in-version recovery (FLAIR) imaging demonstrated additional extensive high-intensity lesions in the gray and subcortical white matter of the left occipital, parietal and temporal lobes. The left thalamus and right cerebellar hemisphere also showed high-intensity abnormalities. Angiography revealed multiple dural arteriovenous fistulas associated with the superior sagittal sinus as well as left transverse sinus thrombosis. The abnormalities seen on MR imaging except for the ischemic region in the left white matter improved after control of the status epilepticus and embolization of the DAVF. Reversible gray matter signal changes induced by status epilepticus have been reported, but not in the case of DAVF. In our patient, cytotoxic and vasogenic edema due to venous hypertension may have caused the diffuse and marked but reversible abnormalities.

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