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The right internal jugular vein, inferior petrous sinus, and cavernous sinus are clearly visible (white arrow head). Initial MRA showing the obstruction of the right vertebral artery at V3 and V4 segments.
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Objective: Vertebro-vertebral arteriovenous fistula (VVAVF) is a rare disorder that often forms a high blood flow shunt. It is mostly due to trauma, but it is occasionally caused by systemic diseases. Segmental arterial mediolysis (SAM) is characterized by non-inflammatory/non-atherosclerotic segmental lysis of the arterial media and is often diagn...
Context in source publication
Context 1
... MRA, the delineation of the V3 and more distal seg- ments of the right vertebral artery was poor, but the sur- rounding venous plexus, inferior petrosal sinus, and cavernous sinus were visualized ( Fig. 1) and a diagnosis of VVAVF was made. Cerebral angiography was carried out, and right vertebral arteriography revealed an arterio- venous fistula in the V3 segment of the right vertebral artery ( Figs. 2A and 2B). Left vertebral arteriography also showed an arteriovenous fistula in the V3 segment of the right vertebral artery via the vertebrobasilar junction. An aneurysm about 8 mm in diameter was also noted at a site distal to the fistula (Fig. 2C). By cone beam CT, the fistula was judged to be located in the V3 segment of the right vertebral artery (Fig. ...
Citations
... Blood blister-like aneurysm 16) and vertebra-vertebral arteriovenous fistula 17) have been reported in cases of head and neck angiopathy due to SAM. However, studies assessing the association between MMAVF and SAM have not been conducted yet. ...
Objective: Middle meningeal arteriovenous fistula (MMAVF) is typically post-traumatic or iatrogenic in origin, but it can have an idiopathic origin in rare cases. Here, we report a case of idiopathic MMAVF complicated by segmental arterial mediolysis (SAM).
Case Presentation: The patient was a 63-year-old woman admitted to our hospital with symptoms of right pulsating tinnitus for the past 2 months. She had no significant medical history. MRI and DSA revealed a right MMAVF. Selective embolization using coils was performed. Seven years later, when she underwent laparotomy for intestinal perforation, multiple aneurysms were found in the abdominal cavity. Left hemicolectomy was performed, and an aneurysm of the gastroepiploic artery was resected. Based on a pathological examination of the aneurysm, the patient was diagnosed with SAM. Coil embolization was performed to prevent rupture.
Conclusion: This case report shows that MMAVF may be associated with SAM. Fistula embolization with coils is an effective treatment of MMAVF associated with SAM. Therefore, it is important to check for systemic diseases, such as SAM when idiopathic MMAVF is detected.
