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(Stroke. 1999;30:2487-2490.)
© 1999 American Heart Association, Inc.

Case Reports

Acquired Pial Arteriovenous Fistula Following Cerebral Vein Thrombosis

Constantine C. Phatouros, MBBS, FRACR; Van V. Halbach, MD; Christopher F. Dowd, MD; Todd E. Lempert, MD; Adel M. Malek, MD, PhD; Philip M. Meyers, MD Randall T. Higashida, MD

From the Division of Interventional Neurovascular Radiology, University of California at San Francisco Medical Center.

Correspondence to Constantine C. Phatouros, MBBS, FRACR, Division of Interventional Neurovascular Radiology, UCSF Medical Center, 505 Parnassus Ave, Room L-352, San Francisco, CA 94143-0628. E-mail con.phatouros{at}radiology.ucsf.edu

Background—We report a unique case of an acquired pial arteriovenous fistula occurring after an asymptomatic thrombosis of a superficial cerebral vein.

Case Description—A cerebral angiogram performed in a 51-year-old man with subarachnoid hemorrhage revealed a 10-mm ruptured anterior communicating artery aneurysm and a thrombosed left superficial middle cerebral vein. Coil embolization of the anterior communicating aneurysm was performed. Follow-up angiography 18 months later revealed a new, asymptomatic, pial arteriovenous fistula between the previously thrombosed left superficial middle cerebral vein and a small sylvian branch of the left middle cerebral artery.

Conclusions—This case provides evidence that pial arteriovenous fistulas may develop as acquired lesions and furthermore may rarely follow cerebral vein thrombosis. Several cases of dural arteriovenous fistulas, as well as a single case of a mixed pial-dural arteriovenous fistula, occurring after dural sinus thrombosis have been reported previously. However, to our knowledge, this is the first report of an acquired pial arteriovenous fistula following a cerebral vein thrombosis.

Key Words: cerebral arteriovenous malformations • etiology • sinus thrombosis • subarachnoid hemorrhage

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