Case Report: 36yrs old young man with post traumatic dural arteriovenous fistula

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Noor UI Huda Maria

Punjab Institute of Neurosciences, Pakistan

: J Spine Neurosurg

Abstract

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Dural arteriovenous fistula (DAVF is defined as an abnormal direct connection between a meningeal artery and a meningeal vein or dural venous sinus and has been classified in various ways, the two most common included the Borden and the Cognard classifications. The pathogenesis of DAVF still remains unclear but sinus thrombosis, head trauma, hypercoagulable states, surgery, and hormonal influence are the considered pre-disposing factors for the condition. The presenting signs and symptoms depend on the location of the fistula. Here we are reporting a case of a young 36yrs old man who presented to us with complaints of increased “ pulsating rustling like ringing sound in ears more so in right ear” (pulsatile tinnitus), headache and rustling flow like feeling in the occiput for the last 10days.Patient had history of a road side traffic accident 8yrs ago where his bike hit another bike and he fell down on the road on the “nape of his head”. He suffered from brief loss of consciousness and amnesia for event as well. He was taken immediately to the nearby emergency facility where he was kept under observation for 72hrs and discharged with special precautions and instructions to the family. The exact injury record was unavailable however the attendant mentioned the doctor said it was “mild head injury”. It was 4yrs ago (4yrs after the accident) when he suffered from severe headache that would start from the back of his head and involved the entire head. The episodes increased in frequency and intensity over time and 2.5yrs ago he started from rustling ringing sounds in his ears. He presented to an otolaryngologist who cleared him for any middle ear infection and referred him to psychiatrist. The symptoms gradually increased in intensity and 10days ago the sound and the headache was too severe that the patient had to immediately present at a local filter clinic where the doctor referred him to our tertiary setup. After radiographical evaluation using CT and MRI a suspicion of posterior fossa dural arteriovenous malformation was made and confirmed with digital substraction angiography (DSA) where an aggressive right sided transverse-sigmoid sinus with cortical venous reflux and cerebral venous thrombosis was confirmed .He was referred to neuro interventional radiologist who proceeded with embolization of the fistula.

Biography

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Noor UI Huda Maria is one of a few female neurosurgeons in Pakistan and youngest Pakistani neurosurgeon to have released a book on neurosurgery with an international publisher .Currently working at Pakistan's largest dedicated neurosurgery hospital ,Punjab institute of neurosciences,she has followed the highest neurosurgery degree thats is Fellowship of College of Physicians and Surgeons Pakistan (FCPS).Graduate of Services Institute of Medical Sciences with top position ,distinctions and gold medals, she has always been passionate about neurosurgery.She has got special interest in research work and has various articles published in national and international journals.She has presented her abstracts and e posters at different international conferences and has been invited as speaker on various different neurosurgical conferences.

E-mail: iii_glow_iii@ymail.com