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Symposium Neuroradiologicum, Bologna, 6.10.2010 F. Signorelli, P. Khoueir, F. Scholtes, D. Roy, M.W. Bojanowski – Dural AV fistulae and Dementia Dural.

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Presentation on theme: "Symposium Neuroradiologicum, Bologna, 6.10.2010 F. Signorelli, P. Khoueir, F. Scholtes, D. Roy, M.W. Bojanowski – Dural AV fistulae and Dementia Dural."— Presentation transcript:

1 Symposium Neuroradiologicum, Bologna, 6.10.2010 F. Signorelli, P. Khoueir, F. Scholtes, D. Roy, M.W. Bojanowski – Dural AV fistulae and Dementia Dural AV fistula & cognitive decline Francesco Signorelli, Paul Khoueir, Felix Scholtes, Daniel Roy, Michel W. Bojanowski Centre Hospitalier de l'Université de Montréal, Canada Università degli Studi "Magna Græcia" di Catanzaro, Italy Centre Hospitalier Universitaire, Université de Liège, Belgium Presentation of 3 cases and integration into the literature

2 Symposium Neuroradiologicum, Bologna, 6.10.2010 F. Signorelli, P. Khoueir, F. Scholtes, D. Roy, M.W. Bojanowski – Dural AV fistulae and Dementia DAVF & cognitive decline CVD: non-haemorrhagic neurological deficits Venous hypertension / congestion Stasis Edema Parenchymal injury

3 Symposium Neuroradiologicum, Bologna, 6.10.2010 F. Signorelli, P. Khoueir, F. Scholtes, D. Roy, M.W. Bojanowski – Dural AV fistulae and Dementia DAVF & cognitive decline Transverse sinus: – Hemispheric white matter

4 Symposium Neuroradiologicum, Bologna, 6.10.2010 F. Signorelli, P. Khoueir, F. Scholtes, D. Roy, M.W. Bojanowski – Dural AV fistulae and Dementia DAVF & cognitive decline Transverse sinus – Hemispheric white matter Straight sinus: – Thalamus

5 Symposium Neuroradiologicum, Bologna, 6.10.2010 F. Signorelli, P. Khoueir, F. Scholtes, D. Roy, M.W. Bojanowski – Dural AV fistulae and Dementia Case 1 M 59y 1 month history – cognitive and behavioural impairment Apathic, non-cooperative, left hemiparesis

6 Symposium Neuroradiologicum, Bologna, 6.10.2010 F. Signorelli, P. Khoueir, F. Scholtes, D. Roy, M.W. Bojanowski – Dural AV fistulae and Dementia Case 1

7 Symposium Neuroradiologicum, Bologna, 6.10.2010 F. Signorelli, P. Khoueir, F. Scholtes, D. Roy, M.W. Bojanowski – Dural AV fistulae and Dementia Case 1 Endovascular treatment: unsuccessful

8 Symposium Neuroradiologicum, Bologna, 6.10.2010 F. Signorelli, P. Khoueir, F. Scholtes, D. Roy, M.W. Bojanowski – Dural AV fistulae and Dementia Case 1 Endovascular treatment: unsuccessful Surgery: clipping of tentorial vein at junction with left lateral mesencephalic vein

9 Symposium Neuroradiologicum, Bologna, 6.10.2010 F. Signorelli, P. Khoueir, F. Scholtes, D. Roy, M.W. Bojanowski – Dural AV fistulae and Dementia Case 1 Endovascular treatment: unsuccessful Surgery: clipping of tentorial vein at junction with left lateral mesencephalic vein Post-op angiography: no residual fistula

10 Symposium Neuroradiologicum, Bologna, 6.10.2010 F. Signorelli, P. Khoueir, F. Scholtes, D. Roy, M.W. Bojanowski – Dural AV fistulae and Dementia Case 1

11 Symposium Neuroradiologicum, Bologna, 6.10.2010 F. Signorelli, P. Khoueir, F. Scholtes, D. Roy, M.W. Bojanowski – Dural AV fistulae and Dementia Case 1

12 Symposium Neuroradiologicum, Bologna, 6.10.2010 F. Signorelli, P. Khoueir, F. Scholtes, D. Roy, M.W. Bojanowski – Dural AV fistulae and Dementia Case 1 Endovascular treatment: unsuccessful Surgery: left temporal craniotomy; clip of tentorial vein at junction with left lateral mesencephalic vein) Post-op angiography: no residual fistula Neurological recovery (at 4 months: minimal residual deficit)

13 Symposium Neuroradiologicum, Bologna, 6.10.2010 F. Signorelli, P. Khoueir, F. Scholtes, D. Roy, M.W. Bojanowski – Dural AV fistulae and Dementia Case 2 M 56y 3 week history – memory loss, confusion, emotional lability Apathic, disorientated. No focal deficit.

14 Symposium Neuroradiologicum, Bologna, 6.10.2010 F. Signorelli, P. Khoueir, F. Scholtes, D. Roy, M.W. Bojanowski – Dural AV fistulae and Dementia Case 2 Endovascular treatment of tentorial DAVF unsuccessful

15 Symposium Neuroradiologicum, Bologna, 6.10.2010 F. Signorelli, P. Khoueir, F. Scholtes, D. Roy, M.W. Bojanowski – Dural AV fistulae and Dementia Case 2 Endovascular treatment of tentorial DAVF unsuccessful Surgery: coagulation and ligation of tentorial vein

16 Symposium Neuroradiologicum, Bologna, 6.10.2010 F. Signorelli, P. Khoueir, F. Scholtes, D. Roy, M.W. Bojanowski – Dural AV fistulae and Dementia Case 2 Endovascular treatment of tentorial DAVF unsuccessful Surgery: coagulation and ligation of tentorial vein Post-op angiography: no residual fistula

17 Symposium Neuroradiologicum, Bologna, 6.10.2010 F. Signorelli, P. Khoueir, F. Scholtes, D. Roy, M.W. Bojanowski – Dural AV fistulae and Dementia Case 2

18 Symposium Neuroradiologicum, Bologna, 6.10.2010 F. Signorelli, P. Khoueir, F. Scholtes, D. Roy, M.W. Bojanowski – Dural AV fistulae and Dementia Case 2 Endovascular treatment of tentorial DAVF unsuccessful Surgery: coagulation and ligation of tentorial vein Post-op angiography: no residual fistula Neurological recovery: return to work within 6 months

19 Symposium Neuroradiologicum, Bologna, 6.10.2010 F. Signorelli, P. Khoueir, F. Scholtes, D. Roy, M.W. Bojanowski – Dural AV fistulae and Dementia Case 3 F 69y <2 month history – cognitive decline: lack of initiative, drowsiness, memory loss Anosognosia, apathy, left hemineglect, -paresis, - hypoesthesia

20 Symposium Neuroradiologicum, Bologna, 6.10.2010 F. Signorelli, P. Khoueir, F. Scholtes, D. Roy, M.W. Bojanowski – Dural AV fistulae and Dementia Case 3

21 Symposium Neuroradiologicum, Bologna, 6.10.2010 F. Signorelli, P. Khoueir, F. Scholtes, D. Roy, M.W. Bojanowski – Dural AV fistulae and Dementia Case 3

22 Symposium Neuroradiologicum, Bologna, 6.10.2010 F. Signorelli, P. Khoueir, F. Scholtes, D. Roy, M.W. Bojanowski – Dural AV fistulae and Dementia Case 3 Endovascular treatment unsuccessful

23 Symposium Neuroradiologicum, Bologna, 6.10.2010 F. Signorelli, P. Khoueir, F. Scholtes, D. Roy, M.W. Bojanowski – Dural AV fistulae and Dementia Case 3 Endovascular treatment unsuccessful Surgery: supracerebellar infratentorial approach in the sitting position with disconnection of tentorial vein

24 Symposium Neuroradiologicum, Bologna, 6.10.2010 F. Signorelli, P. Khoueir, F. Scholtes, D. Roy, M.W. Bojanowski – Dural AV fistulae and Dementia Case 3 Endovascular treatment unsuccessful Surgery: supracerebellar infratentorial approach in the sitting position with disconnection of tentorial vein Post-op angiography: no residual fistula

25 Symposium Neuroradiologicum, Bologna, 6.10.2010 F. Signorelli, P. Khoueir, F. Scholtes, D. Roy, M.W. Bojanowski – Dural AV fistulae and Dementia Case 3

26 Symposium Neuroradiologicum, Bologna, 6.10.2010 F. Signorelli, P. Khoueir, F. Scholtes, D. Roy, M.W. Bojanowski – Dural AV fistulae and Dementia Case 3 Endovascular treatment unsuccessful Surgery: supracerebellar infratentorial approach in the sitting position with disconnection of tentorial vein Post-op angiography: no residual fistula Neurological recovery for 6 weeks Pulmonary embolism resulted in death

27 Symposium Neuroradiologicum, Bologna, 6.10.2010 F. Signorelli, P. Khoueir, F. Scholtes, D. Roy, M.W. Bojanowski – Dural AV fistulae and Dementia DAVF & cognitive decline 43 cases reported (+ the present 3) Age 43-80 (mean 63) M/F = 3/1 (74% vs 26%)

28 Symposium Neuroradiologicum, Bologna, 6.10.2010 F. Signorelli, P. Khoueir, F. Scholtes, D. Roy, M.W. Bojanowski – Dural AV fistulae and Dementia DAVF & cognitive decline CT / MRI diagnostic – but: 5/46 initially « normal » (until contrast administration) Weak or no correlation between severity of images and symptoms

29 Symposium Neuroradiologicum, Bologna, 6.10.2010 F. Signorelli, P. Khoueir, F. Scholtes, D. Roy, M.W. Bojanowski – Dural AV fistulae and Dementia The transverse sinus 18/26 : diffuse white matter anomaly (8/26: abnormal vessels) DAVF topography: – 4 (15%) bilateral, 12 (46%) right, 10 (38%) left Sinus occlusion (NB: not all reported) : ≧ 73% (19/26) – 10 bilateral, 5 right, 4 left Time to presentation: – 88% > 2 months (23/26)

30 Symposium Neuroradiologicum, Bologna, 6.10.2010 F. Signorelli, P. Khoueir, F. Scholtes, D. Roy, M.W. Bojanowski – Dural AV fistulae and Dementia The straight sinus 100% : thalamus DAVF topography: tentorial edge or falcotentorial junction Straight sinus occlusion (NB: not all reported) : ≧ 75% (9/12) Time to presentation: – 73% < 2 months (8/11) – 18% >2 months but severe (2/11) – 9% >2 months, moderate (1/11)

31 Symposium Neuroradiologicum, Bologna, 6.10.2010 F. Signorelli, P. Khoueir, F. Scholtes, D. Roy, M.W. Bojanowski – Dural AV fistulae and Dementia The superior sagittal sinus Both presentations possible 2/8: thalamus (retrograde flow vein of Galen) Time to presentation – White matter: >2 months – Thalamus: <2 months

32 Symposium Neuroradiologicum, Bologna, 6.10.2010 F. Signorelli, P. Khoueir, F. Scholtes, D. Roy, M.W. Bojanowski – Dural AV fistulae and Dementia DAVF & cognitive decline Evolution: thalamic more rapid Main prognostic factors – Negative: severity of symptoms – Positive: completeness of treatment

33 Symposium Neuroradiologicum, Bologna, 6.10.2010 F. Signorelli, P. Khoueir, F. Scholtes, D. Roy, M.W. Bojanowski – Dural AV fistulae and Dementia DAVF & cognitive decline DAVF: potentially curable cause of dementia Earliest possible & complete treatment: best prognosis Thalamic : more rapid evolution

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