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Correspondence |

An Intracranial Dural Arteriovenous Fistula Found During a Dermatologic Examination

Yue Yu, MD, PhD; Julian K. Wu, MD; Adel M. Malek, MD, PhD; Daniel T. Finn, MD
Arch Dermatol. 2010;146(7):808-810. doi:10.1001/archdermatol.2010.144.
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Newton  THCronqvist  S Involvement of the dural arteries in intracranial arteriovenous malformations. Radiology 1969;93 (5) 1071- 1078
PubMed Link to Article[[XSLOpenURL/10.1148/93.5.1071]]
Safavi-Abbasi  SDi Rocco  FNakaji  P  et al.  Thrombophilia due to factor V and factor II mutations and formation of a dural arteriovenous fistula: case report and review of a rare entity. Skull Base 2008;18 (2) 135- 143
PubMed Link to Article[[XSLOpenURL/10.1055/s-2007-1003926]]
Borden  JAWu  JKShucart  WA A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment. J Neurosurg 1995;82 (2) 166- 179
PubMed Link to Article[[XSLOpenURL/10.3171/jns.1995.82.2.0166]]
Roy  DRaymond  J The role of transvenous embolization in the treatment of intracranial dural arteriovenous fistulas. Neurosurgery 1997;40 (6) 1133- 1141
PubMed Link to Article[[XSLOpenURL/10.1097/00006123-199706000-00004]]
Malek  AMHalbach  VVHigashida  RTPhatouros  CCMeyers  PMDowd  CF Treatment of dural arteriovenous malformations and fistulas. Neurosurg Clin N Am 2000;11 (1) 147- 166
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Figure 1.

Clinical (A) and computed tomography angiography (CTA) images (B-D) of dilated scalp arteries. A, The prominent scalp artery outlined with the box was easily palpable during examination (inset shows artery half surrounded by arrows). B, The CTA imaging reveals underlying dilated scalp arteries. C, The arteries form an extraosseous medusalike confluence. D, Branches of the bilateral occipital and superficial temporal arteries centered near the sagittal sinus are associated with a dilated large intracranial varix.

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Figure 2.

Computed tomography angiography (CTA) (A) and catheter cerebral angiography (CCA) images (B-E) of the scalp vessels. A, Coronal CTA reveals the intra-axial varix associated with prominent cortical veins, suggesting a cerebral arteriovenous malformation (AVM). B, The CCA image of the right internal carotid artery in anteroposterior (AP) view reveals no evidence of the abnormal arteriovenous shunting that would be expected in a cerebral AVM. C, Injection of the right external carotid artery in AP view demonstrates dilated arterial scalp feeders (occipital and superficial temporal arteries) as well as middle meningeal feeders to a parasagittal dural arteriovenous fistula in the lateral wall of the superior sagittal sinus with retrograde cortical venous drainage into a large dilated venous varix. D and E, Lateral early (D) and late (E) injections of the right external carotid artery highlight the early venous shunting and dilated cortical veins indicative of extensive cortical venous drainage.

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