Hostname: page-component-76d6cb85b7-s74w7 Total loading time: 0 Render date: 2026-07-15T07:26:10.055Z Has data issue: false hasContentIssue false
  • English
  • Français

A dural arteriovenous fistula associated with an encephalocele presenting as otitis media with effusion

Published online by Cambridge University Press:  16 October 2018

W Ahmed ,
S Connor ,
R Obholzer  and
I Pai
W Ahmed*
Affiliation:
Department of Otolaryngology, London, UK
S Connor
Affiliation:
Department of Radiology, Guy's and St Thomas’ NHS Foundation Trust, London, UK
R Obholzer
Affiliation:
Department of Otolaryngology, London, UK
I Pai
Affiliation:
Department of Otolaryngology, London, UK
*
Author for correspondence: Mr Waseem Ahmed, Department of Otolaryngology, Guy's and St Thomas’ NHS Foundation Trust, London, UK E-mail: waseem.ahmed6@nhs.net
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

This case report illustrates an unusual case of a dural arteriovenous fistula and an associated encephalocele presenting as otitis media with effusion.

Case report

A 53-year-old man presented with right-sided hearing loss and aural fullness of 2 years’ duration. Examination revealed ipsilateral post-auricular pulsatile tenderness. Computed tomography showed transcalvarial channels suggestive of dural arteriovenous fistula. Further magnetic resonance imaging demonstrated the presence of a temporal encephalocele herniating through the tegmen tympani defect, as well as the abnormal vascularity. Angiography confirmed a Cognard type I dural arteriovenous fistula, which is being managed conservatively. Surgical repair of the encephalocele was recommended but declined by the patient.

Conclusion

Dural arteriovenous fistula is an uncommon intracranial vascular malformation rarely seen by otolaryngologists, with pulsatile tinnitus being the usual presentation. To our knowledge, this is the first reported case of dural arteriovenous fistula presenting with conductive hearing loss and otalgia.

Keywords

Hearing LossOtitis Media With EffusionEncephaloceleArteriovenous FistulaTemporal Bone

Information

Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 132 , Issue 11 , November 2018 , pp. 1032 - 1035
Copyright
Copyright © JLO (1984) Limited, 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

Footnotes

Mr W Ahmed takes responsibility for the integrity of the content of the paper

References

1Seibert, JW, Danner, CJ. Eustachian tube function and the middle ear. Otolaryngol Clin North Am 2006;39:1221–35Google Scholar
2Satomi, J, Satoh, K. Epidemiology and etiology of dural arteriovenous fistula. Brain Nerve 2008;60:883–6Google Scholar
3Gupta, AK, Periakaruppan, AL. Intracranial dural arteriovenous fistulas: a review. Indian J Radiol Imaging 2009;19:43–8Google Scholar
4Berenstein, A, Lasjuanias, P. Dural arteriovenous shunts. In: Lasjaunias, P, Berenstein, A. Surgical Neuroangiography. Vol. 2: Clinical and Endovascular Treatment Aspects in Adults. Berlin: Springer-Verlag, 2004;565–607Google Scholar
5Gandhi, D, Chen, J, Pearl, M, Huang, J, Gemmete, JJ, Kathuria, S. Intracranial dural arteriovenous fistulas: classification, imaging findings, and treatment. AJNR Am J Neuroradiol 2012;33:1007–13Google Scholar
6Hurst, RW, Bagley, LJ, Galetta, S, Glosser, G, Lieberman, AP, Trojanowski, J et al. Dementia resulting from dural arteriovenous fistulas: the pathologic findings of venous hypertensive encephalopathy. AJNR Am J Neuroradiol 1998;19:1267–73Google Scholar
7Cognard, C, Casasco, A, Toevi, M, Houdart, E, Chiras, J, Merland, JJ. Dural arteriovenous fistulas as a cause of intracranial hypertension due to impairment of cranial venous outflow. J Neurol Neurosurg Psychiatry 1998;65:308–16Google Scholar
8Strom, RG, Botros, JA, Refai, D, Moran, CJ, Cross, DT 3rd, Chicoine, MR et al. Cranial dural arteriovenous fistulae: asymptomatic cortical venous drainage portends less aggressive clinical course. Neurosurgery 2009;64:241–7Google Scholar
9Satomi, J, van Dijk, JM, Terbrugge, KG, Willinsky, RA, Wallace, MC. Benign cranial dural arteriovenous fistulas: outcome of conservative management based on the natural history of the lesion. J Neurosurg 2002;97:767–70Google Scholar
10van Dijk, JM, Korsten-Meijer, AG, Mazuri, A. Epistaxis caused by a dural AV-fistula at the cribriform plate. Laryngoscope 2014;124:2476–7Google Scholar
11Alatakis, S, Koulouris, G, Stuckey, S. CT-demonstrated transcalvarial channels diagnostic of dural arteriovenous fistula. AJNR Am J Neuroradiol 2005;26:2393–6Google Scholar
12Cognard, C, Gobin, YP, Pierot, L, Bailly, AL, Houdart, E, Casasco, A et al. Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. Radiology 1995;194:671–80Google Scholar
13Davies, MA, Ter Brugge, K, Willinsky, R, Wallace, MC. The natural history and management of intracranial dural arteriovenous fistulae. Part 2: aggressive lesions. Interv Neuroradiol 1997;3:303–11Google Scholar
14van Dijk, JM, terBrugge, KG, Willinsky, RA, Wallace, MC. Clinical course of cranial dural arteriovenous fistulas with long-term persistent cortical venous reflux. Stroke 2002;33:1233–6Google Scholar
15Kwon, BJ, Han, MH, Kang, HS, Chang, KH. MR imaging findings of intracranial dural arteriovenous fistulas: relations with venous drainage patterns. AJNR Am J Neuroradiol 2005;26:2500–7Google Scholar
16Farb, RI, Agid, R, Willinsky, RA, Johnstone, DM, Terbrugge, KG. Cranial dural arteriovenous fistula: diagnosis and classification with time-resolved MR angiography at 3 T. AJNR Am J Neuroradiol 2009;30:1546–51Google Scholar
17Willems, PW, Brouwer, PA, Barfett, JJ, terBrugge, KG, Krings, T. Detection and classification of cranial dural arteriovenous fistulas using 4D-CT angiography: initial experience. AJNR Am J Neuroradiol 2011;32:49–53Google Scholar
18Kaufman, B, Yonas, H, White, RJ, Miller, CF 2nd. Acquired middle cranial fossa fistulas: normal pressure and nontraumatic in origin. Neurosurgery 1979;5:466–72Google Scholar
19Willems, PW, Willinsky, RA, Segev, Y, Agid, R. Aggressive intracranial dural arteriovenous fistula presenting with cerebrospinal fluid rhinorrhea: case report. Neurosurgery 2009;65:E1208–9Google Scholar