PMC7271059_01
Magnetic resonance imaging. (a, b) Fluid-attenuated inversion recovery (FLAIR) imaging showing widespread hyperintensity diffusely involving the right pons on day 1. (c) Magnetic resonance angiography showing an abnormal flow signal (arrow) posterolateral to the cavernous sinus. Arrowhead indicates the right internal carotid artery. (d) FLAIR imaging. Brainstem edema has worsened and expanded rostrocaudally on day 2. (e) Diffusion-weighted showing shows hyperintense lesion within the edematous pons. (f) T2 star-weighted imaging showing an area of low intensity, suggesting venous congestion and hemorrhage.
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Magnetic resonance imaging (MRI) revealed fluid-attenuated inversion recovery (FLAIR) hyperintensity, dominant on the right side (Figures 1(a) and 1(b)). Magnetic resonance angiography suggested a faint flow signal abnormality posterolateral to the cavernous sinus (CS) (Figure 1(c)). Pontine swelling had worsened (Figure 1(d)), and DWI hyperintensity had appeared (Figure 1(e)). T2 star-weighted imaging showed an area of low intensity (Figure 1(f)), suggesting venous congestion and hemorrhage.
(a) Anteroposterior view of the right external carotid artery angiogram and (b) lateral view of the right internal carotid artery angiogram demonstrate a right-sided cavernous sinus dural arteriovenous fistula (white arrow) draining into the superior petrosal sinus (black arrow) and petrosal vein (double arrow). Note the retrograde venous drainage into the brainstem and cerebellar cortical veins (arrowheads). (c) Axial maximum intensity projection images of the right internal carotid artery angiogram. White arrow indicates the cavernous sinus dural arteriovenous fistula. No bridging veins other than the superior petrosal sinus (black arrow) and petrosal vein (double arrow) are detected.
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DSA revealed a right-sided CS dAVF with venous reflux into the brainstem and cerebellar cortical veins via the right superior petrosal sinus and petrosal vein (Figures 2(a)-2(c)).