Neuropyschological profile of reversible cognitive impairment in a patient with a dural arteriovenous fistula

Document Type

Article

Abstract

Objective and Importance: Patients with dural arteriovenous fistulas (dAVFs) may present with cognitive impairment secondary to venous hypertension or ischemia. Clinical Presentation: We present a patient with a dAVF supplied by the posterior meningeal artery who presented with severe encephalopathy and imaging consistent with bilateral thalamic ischemia. Results: Detailed pre-operative neuropsychological testing documented severe cognitive deficits across multiple domains, localizing diffusely in the cerebral cortex, beyond that which would be expected from purely thalamic involvement. Approximately 2 months following a combined endovascular and surgical repair, repeat neuropsychological testing documented a dramatic improvement in cognitive symptoms while MRI abnormalities in the thalami resolved. Conclusion: Detailed neuropsychological testing may be useful in patients presenting with dAVFs in order to identify cognitive impairment, which may be out of proportion to imaging findings. Recognition of dAVF-associated cognitive impairment may lead to more aggressive, timely treatment in patients with otherwise lower-risk lesions. This detailed testing can also provide a baseline in order to document cognitive recovery after fistula repair.

Publication Date

9-1-2008

Publication Title

Neurocase

ISSN

13554794

E-ISSN

14653656

Volume

14

Issue

3

First Page

231

Last Page

238

PubMed ID

18609005

Digital Object Identifier (DOI)

10.1080/13554790802232677

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