Rapidly Evolving Acute Brainstem Syndrome With Respiratory Insufficiency due to Intracranial Dural Arteriovenous Fistula.
Lim, Hong Kiat Street, Duncan Chong, Wen-Xern Samra, Amrit-Deep
Lim, Hong Kiat
Street, Duncan
Chong, Wen-Xern
Samra, Amrit-Deep
Abstract
A 52-year-old female presented with one week of progressive quadriparesis followed by the development of diplopia, dysphonia and dysphagia over 48 h. Initial impression was of an inflammatory myelitis given mild cerebrospinal fluid pleocytosis and diffuse cervical cord swelling extending to the lower brainstem on MRI. Treatment with intravenous methylprednisolone was commenced. Her condition continued to progress with a brief cardiac arrest secondary to diaphragmatic insufficiency due to brainstem involvement. She survived the cardiac arrest after a period of cardiopulmonary resuscitation and was admitted to the intensive care unit. Subsequent MRI suggested a chronic right sigmoid venous sinus thrombosis with venous congestion in the brainstem and upper cervical cord. Digital subtraction angiogram revealed a right dural arteriovenous fistula (DAVF) between the right transverse venous sinus and perimesecephalic veins. The dural arteriovenous fistula was embolised with subsequent rapid improvement in bulbar function. Limb weakness also improved, and she was transferred to a rehabilitation unit for physiotherapy. Our case highlights the importance of rapid recognition of an intracranial DAVF mimicking an inflammatory myelitis in the setting of an acute brainstem syndrome. Symptoms can progress quickly if untreated with the risk of progression following the administration of corticosteroids.
MIDER Authors
Affiliations
Department of Neurology, York Hospital, York and Scarborough Teaching Hospitals NHS Foundation Trust, Wigginton Road Clifton, York, YO31 8HE, UK; Department of Neurology, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK; Department of Radiology, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK.
Date
2026-05-04
Type
Article
Collections
Citation
Case Reports in Neurological Medicine. 2026 May 4:2026:8666719