Acute confusional syndrome from a dural arteriovenous fistula

Emily R. Lantz, Sean D. Lavine, Joanne R. Festa, E. Sander Connolly, Clinton B Wright, Ronald M. Lazar

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

OBJECTIVE: We describe a case of an acute confusional state associated with a right parietal dural arteriovenous fistula. CLINICAL PRESENTATION: A 67-year-old man in his usual state of health experienced an acute confusion episode preceded by a valsalva maneuver. The episode lasted approximately 60 minutes. Afterward he was able to remember everything that occurred. A magnetic resonance imaging scan suggested a right parietal dural arteriovenous fistula, which was confirmed by angiography. A seizure was ruled out by clinical examination and an electroencephalogram. INTERVENTION: The patient underwent therapeutic embolization and surgical ligation of the fistula. Feeding vessels to the malformation were cauterized within the leaves of the falx, and the draining vein was clipped with a titanium aneurysm clip and divided. An intraoperative angiogram was then performed, which showed obliteration of the fistula. There was no demonstrable confusion or memory loss noted postoperatively. CONCLUSION: We propose that venous hypertension from the dural arteriovenous fistula in combination with a valsalva maneuver caused ischemia in the right parietal lobe, eliciting a deficit in attention.

Original languageEnglish
JournalNeurosurgery
Volume65
Issue number1
DOIs
StatePublished - Jul 1 2009
Externally publishedYes

Fingerprint

Central Nervous System Vascular Malformations
Confusion
Valsalva Maneuver
Fistula
Angiography
Therapeutic Embolization
Parietal Lobe
Memory Disorders
Titanium
Surgical Instruments
Aneurysm
Ligation
Electroencephalography
Veins
Seizures
Ischemia
Magnetic Resonance Imaging
Hypertension
Health

Keywords

  • Confusional state
  • Dural arteriovenous fistula
  • Ischemia
  • Venous hypertension

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Lantz, E. R., Lavine, S. D., Festa, J. R., Connolly, E. S., Wright, C. B., & Lazar, R. M. (2009). Acute confusional syndrome from a dural arteriovenous fistula. Neurosurgery, 65(1). https://doi.org/10.1227/01.NEU.0000348547.56171.EB

Acute confusional syndrome from a dural arteriovenous fistula. / Lantz, Emily R.; Lavine, Sean D.; Festa, Joanne R.; Connolly, E. Sander; Wright, Clinton B; Lazar, Ronald M.

In: Neurosurgery, Vol. 65, No. 1, 01.07.2009.

Research output: Contribution to journalArticle

Lantz, ER, Lavine, SD, Festa, JR, Connolly, ES, Wright, CB & Lazar, RM 2009, 'Acute confusional syndrome from a dural arteriovenous fistula', Neurosurgery, vol. 65, no. 1. https://doi.org/10.1227/01.NEU.0000348547.56171.EB
Lantz ER, Lavine SD, Festa JR, Connolly ES, Wright CB, Lazar RM. Acute confusional syndrome from a dural arteriovenous fistula. Neurosurgery. 2009 Jul 1;65(1). https://doi.org/10.1227/01.NEU.0000348547.56171.EB
Lantz, Emily R. ; Lavine, Sean D. ; Festa, Joanne R. ; Connolly, E. Sander ; Wright, Clinton B ; Lazar, Ronald M. / Acute confusional syndrome from a dural arteriovenous fistula. In: Neurosurgery. 2009 ; Vol. 65, No. 1.
@article{46fe7d4fc0804b23a9d287271ce8ec99,
title = "Acute confusional syndrome from a dural arteriovenous fistula",
abstract = "OBJECTIVE: We describe a case of an acute confusional state associated with a right parietal dural arteriovenous fistula. CLINICAL PRESENTATION: A 67-year-old man in his usual state of health experienced an acute confusion episode preceded by a valsalva maneuver. The episode lasted approximately 60 minutes. Afterward he was able to remember everything that occurred. A magnetic resonance imaging scan suggested a right parietal dural arteriovenous fistula, which was confirmed by angiography. A seizure was ruled out by clinical examination and an electroencephalogram. INTERVENTION: The patient underwent therapeutic embolization and surgical ligation of the fistula. Feeding vessels to the malformation were cauterized within the leaves of the falx, and the draining vein was clipped with a titanium aneurysm clip and divided. An intraoperative angiogram was then performed, which showed obliteration of the fistula. There was no demonstrable confusion or memory loss noted postoperatively. CONCLUSION: We propose that venous hypertension from the dural arteriovenous fistula in combination with a valsalva maneuver caused ischemia in the right parietal lobe, eliciting a deficit in attention.",
keywords = "Confusional state, Dural arteriovenous fistula, Ischemia, Venous hypertension",
author = "Lantz, {Emily R.} and Lavine, {Sean D.} and Festa, {Joanne R.} and Connolly, {E. Sander} and Wright, {Clinton B} and Lazar, {Ronald M.}",
year = "2009",
month = "7",
day = "1",
doi = "10.1227/01.NEU.0000348547.56171.EB",
language = "English",
volume = "65",
journal = "Neurosurgery",
issn = "0148-396X",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Acute confusional syndrome from a dural arteriovenous fistula

AU - Lantz, Emily R.

AU - Lavine, Sean D.

AU - Festa, Joanne R.

AU - Connolly, E. Sander

AU - Wright, Clinton B

AU - Lazar, Ronald M.

PY - 2009/7/1

Y1 - 2009/7/1

N2 - OBJECTIVE: We describe a case of an acute confusional state associated with a right parietal dural arteriovenous fistula. CLINICAL PRESENTATION: A 67-year-old man in his usual state of health experienced an acute confusion episode preceded by a valsalva maneuver. The episode lasted approximately 60 minutes. Afterward he was able to remember everything that occurred. A magnetic resonance imaging scan suggested a right parietal dural arteriovenous fistula, which was confirmed by angiography. A seizure was ruled out by clinical examination and an electroencephalogram. INTERVENTION: The patient underwent therapeutic embolization and surgical ligation of the fistula. Feeding vessels to the malformation were cauterized within the leaves of the falx, and the draining vein was clipped with a titanium aneurysm clip and divided. An intraoperative angiogram was then performed, which showed obliteration of the fistula. There was no demonstrable confusion or memory loss noted postoperatively. CONCLUSION: We propose that venous hypertension from the dural arteriovenous fistula in combination with a valsalva maneuver caused ischemia in the right parietal lobe, eliciting a deficit in attention.

AB - OBJECTIVE: We describe a case of an acute confusional state associated with a right parietal dural arteriovenous fistula. CLINICAL PRESENTATION: A 67-year-old man in his usual state of health experienced an acute confusion episode preceded by a valsalva maneuver. The episode lasted approximately 60 minutes. Afterward he was able to remember everything that occurred. A magnetic resonance imaging scan suggested a right parietal dural arteriovenous fistula, which was confirmed by angiography. A seizure was ruled out by clinical examination and an electroencephalogram. INTERVENTION: The patient underwent therapeutic embolization and surgical ligation of the fistula. Feeding vessels to the malformation were cauterized within the leaves of the falx, and the draining vein was clipped with a titanium aneurysm clip and divided. An intraoperative angiogram was then performed, which showed obliteration of the fistula. There was no demonstrable confusion or memory loss noted postoperatively. CONCLUSION: We propose that venous hypertension from the dural arteriovenous fistula in combination with a valsalva maneuver caused ischemia in the right parietal lobe, eliciting a deficit in attention.

KW - Confusional state

KW - Dural arteriovenous fistula

KW - Ischemia

KW - Venous hypertension

UR - http://www.scopus.com/inward/record.url?scp=67651177982&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=67651177982&partnerID=8YFLogxK

U2 - 10.1227/01.NEU.0000348547.56171.EB

DO - 10.1227/01.NEU.0000348547.56171.EB

M3 - Article

C2 - 19574802

AN - SCOPUS:67651177982

VL - 65

JO - Neurosurgery

JF - Neurosurgery

SN - 0148-396X

IS - 1

ER -