Neurocirugía Neurocirugía
Neurocirugia.2004;15:458-67 - Vol. 15 Núm.05 DOI: 10.1016/S1130-1473(04)70458-3

Malformación arteriovenosa dural del seno transverso-sigmoide no sangrante manifestada por síntomas focales y coma

J.C. Palominoa, R.D. Lobatoa, J. Campolloa, J. Fernández-Alena, A. Lagaresa

a Service of Neurosurgery and Section of Neuroradiology. Hospital “12 de Octubre”. Faculty of Medicine. University Complutense. Madrid

Keywords

Arteriovenous malformation. Dural arteriovenous malformation. Venous sinuses. Ischemia. Intra-cranial pressure. Venous thrombosis. Coma. Endovascular embolization. Hyperhomocysteinemia.

Resumen

Se presenta el caso de un hombre de 63 años con una malformación arteriovenosa dural de la región del seno transverso-sigmoide que debutó con síntomas focales para desarrollar después déficit de funciones superiores y finalmente estupor y coma. La angiografía cerebral inicial mostró drenaje venoso retrogrado hacia venas cerebrales corticales y profundas con un marcado retardo del tiempo angiográfico. Tras la práctica de embolización transarterial los síntomas revirtieron por completo, al tiempo que la angiografia de control mostró una normalización del drenaje venoso que se hizo anterógrado. Cuatro meses después los síntomas recurrieron coincidiendo con la reaparición de drenaje venoso cerebral retrógrado cuando el paciente presentó trombosis del seno longitudinal superior, del seno transverso-sigmoide derecho y de la arteria central de la retina en el contexto de hipercoagulabilidad secundaria a hiperhomocisteinemia. La angiografía cerebral de control mostró persistencia de fístula AV y drenaje venoso retrógrado por lo que se procedió a resecar las estructuras durales implicadas, logrando la curación definitiva.

El mecanismo fisiopatológico responsable de los síntomas en nuestro paciente fue probablemente isquémico de origen venoso secundaria a la hipertensión del sector venoso causada por la fistula AV dural. Se revisa la presentación clínica y angiográfica en casos similares reportados en la literatura.

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