Reversible cytotoxic edema associated with dural arterio venous fistula: A case report

MEN S., Idiman F., GÜLCÜ A., Örmeci B., Paköz B.

European Journal of Radiology Extra, vol.52, no.1, pp.1-5, 2004 (Scopus) identifier

  • Publication Type: Article / Article
  • Volume: 52 Issue: 1
  • Publication Date: 2004
  • Doi Number: 10.1016/j.ejrex.2004.07.002
  • Journal Name: European Journal of Radiology Extra
  • Journal Indexes: Scopus
  • Page Numbers: pp.1-5
  • Keywords: Cytotoxic edema, Diffusion weighted imaging, Dural arterio venous fistula
  • Dokuz Eylül University Affiliated: Yes


Dural arterio venous fistulas with restricted antegrade venous flow and reflux into a dural sinus or cortical veins lead to intracranial venous hypertension. This type of venous hypertension in return may cause parenchymal damage with mechanisms similar to those proposed for venous infarction. A 67-year-old female presented with mixed aphasia and loss of consciousness that had progressed within the last 24 h. T2 and fluid attenuated inversion recovery weighted magnetic resonance images showed prominent cortical veins and diffuse white matter hyperintensity in the temporal, parietal and occipital lobes. The hyperintense areas also showed restricted diffusion on the diffusion weighted imaging. Angiography confirmed durai arteriovenous fistula of the torcular herofili, severe stenosis of the right transverse-sigmoid sinus junction, occlusion of the left sigmoid sinus and reversal of the flow in the superior sagittal sinus. The stenotic sinus was dilated with balloon angioplasty, while the fistula was treated with particle embolization. This report emphasizes on unusual coexistence of cytotoxic edema with dural arteriovenous fistula and its reversal after elimination of venous outflow obstruction. © 2004 Elsevier Ireland Ltd. All rights reserved.