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Neurological picture
Bilateral thalamic venous hypertension caused by a tentorial dural arteriovenous fistula: endovascular treatment
  1. Alejandro Santillan1,
  2. Joseph E Safdieh2,
  3. Y Pierre Gobin1,
  4. Athos Patsalides1
  1. 1Division of Interventional Neuroradiology, Department of Neurological Surgery, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, USA
  2. 2Department of Neurology, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, USA
  1. Correspondence to Alejandro Santillan, 525 E. 68th St, Division of Interventional Neuroradiology, Department of Neurological Surgery, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY 10065, USA; als2052{at}med.cornell.edu

https://doi.org/10.1136/jnnp.2010.231969

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    A 50-year-old right-handed man with a history of disorganised, manic-type behaviour and formal thought disorder for many years presented to the hospital in an acute confusional state. Cross-sectional imaging studies of the brain (CT and MRI) showed diffuse oedema and petechial haemorrhages in the bilateral thalami (figure 1A), occlusion of the straight venous sinus and abnormal vessels along the tentorium. A catheter angiogram demonstrated a tentorial medial-type dural arteriovenous fistula (dAVF), according to Picard's classification, of the right hemitentorium supplied by the medial tentorial artery (MTA) of Bernasconi-Cassinari of the right internal carotid artery (ICA), the right middle meningeal artery (MMA) and the right occipital artery. There was early retrograde venous flow in the vein of Galen, the basal veins of Rosenthal and the internal cerebral veins bilaterally (figure 1B). The dAVF …

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    Footnotes

    • Patient consent Obtained.

    • Ethics approval This study was conducted with the approval of the New York Presbyterian Hospital.

    • Provenance and peer review Not commissioned; externally peer reviewed.