Subcortical Edema Presenting as a Focal Seizure—Diagnosis and Management

A 58-year-old gentleman came in emergency with sudden onset of involuntary movement in right hand only and mild headache. No history of loss of consciousness and focal weakness was there. On examination, he was conscious, following commands, and symptoms subsided with loading dose of Lacosamide injection. MR brain showed focal subcortical white matter edema in left precentral frontal region, further CT angiogram and venogram was done to rule out any vascular malformation or CVT. No evidence of any vascular malformation or CVT on CT. On late venous phase of CT VENO, subtle delayed filling and paucity of veins were seen in left high fronto-parietal region. On this subtle finding probability of dural AVF was raised. Immediately DSA was done which showed type III dural AVF directly draining into subarachnoid veins with reflux causing venous hypertension and resultant subcortical edema in corresponding area. Successful embolization was done using onyx with complete curative embolization of dural AVF. Patient discharged without any deficit with no further seizures on 1-year follow-up.

Conclusion: Subcortical edema may be a feature of dural AVF which can be missed on conventional CT/MRI. DSA is investigation of choice and timely diagnosis can save life.

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Artikel online veröffentlicht:
12. September 2024