Giovanni Alano Vista, Noel Belonguel and Reynaldo Benedict Villamor
Perpetual Succour Hospital, Philippines
Posters & Accepted Abstracts: J Neurol Neurophysiol
Spontaneous Acute Subdural Hematoma (ASDH) comprises 2.6% of all ASDH. In one recent study, only 178 cases of spontaneous ASDH were documented, however, only one of them was attributed to the presence of dural Arteriovenous Fistula (dAVF). Only less than 10% of all Subarachnoid Hemorrhage (SAH) are caused by vascular malformations. Spontaneous ASDH and SAH occurring together are extremely rare. There is a scarcity of literature on cases with dAVF of the occipital lobe as a cause of simultaneous spontaneous ASDH and SAH. A 44-year old Filipino male with no history of trauma, presented with severe headache, vomiting and decreasing sensorium; CT scan revealed acute parenchymal bleed in the left occipital lobe with subarachnoid extension and subdural hematoma in the left frontoparietotemporal convexity along the tentorium cerebeli and posterior interhemispheric falx. Due to the location of the lesion seen on CT scan and the gender distribution, arteriovenous malformation was initially considered, thus proceeded to CTA to establish the diagnosis of vascular anomaly, however, revealed dAVF instead. Four-vessel angiogram was done to assess the tributaries of the dAVF and confirmed the diagnosis. Complete obliteration of dAVF of the occipital lobe was done with Onyx Embolization in one session. This is the first case of Borden type II, Cognard type IIa+IIb dAVF, as reported in this institution. Although rare as a cause of SAH and ASDH, dAVF should be considered as a differential in patients with the absence of identifiable common cause of new onset of severe headache and poor neurologic status.
Giovanni Alano Vista has graduated from Cebu Institute of Medicine. Presently, he is a Resident in the Department of Internal Medicine in Perpetual Succour Hospital. He was recently offered a position of Research Subinvestigator for Perpetual Succour Hospital, Cebu Cancer Institute.
E-mail: giovistalano124@gmail.com
