Article Figures & Data
Figures
- Fig 1.
Patient 1, a 73-year-old man who presented with incoordination and ataxia.
A, Parasagittal T1-weighted MR image shows a low-signal-intensity lesion involving the posterior inferior aspect of the cerebellar hemisphere.
B, Axial T2-weighted MR image shows an ill-defined high-signal-intensity lesion (asterisk) in the left cerebellar hemisphere. Note multiple signal voids in the peripheral portion of the lesion.
C, Axial gadolinium-enhanced T1-weighted image demonstrates intense peripheral enhancement of the left hemispheric lesion, with a central nonenhancing area.
D, Left external carotid artery angiogram demonstrates DAVF (short thick black arrow) supplied by meningeal artery of cerebellar (Mening. a. of Cbll.) fossa coming from a neuromeningeal branch of the right ascending pharyngeal artery and left occipital artery (Occp. A.) draining through the inferior hemispheric vein (curved arrow).
- Fig 2.
A–C, Axial T2-weighted MR images in patient 5 (A), patient 2 (B), and patient 4 (C) show high signal intensity of the lesion, with various degrees of signal voids.
- Fig 3.
A–C, Gadolinium enhanced T1-weighted MR images in patient 3 (A, coronal), patient 2 (B, axial), and patient 4 (C, coronal) show diffuse peripheral enhancement.
- Fig 4.
A and B, Lateral (A) and anterioposterior (B) selective angiograms of the meningeal artery of the cerebellar (Mening. A. of Cbll.) fossa in patient 3 show a DAVF draining into the inferior vermian vein (Inf. Verm. V.) via a short tentorial sinus (Tent.S.).
C, Right vertebral angiogram in patient 4 demonstrates enlarged artery of the falx cerebelli (A.of Falx Cbll.) supplying a DAVF and draining into the right inferior hemispheric vein (Inf.Hemsp. V.) through the tentorial sinus (Tent.S.)
Tables
Clinical, MR, and angiographic findings of aggressive DAVF involving the cerebellar hemisphere
Characteristic Patient 1 Patient 2 Patient 3 Patient 4 Patient 5 Patient 6 Age (y)/sex 73/M 67/M 72/M 88/F 79/M 59/M Clinical findings Incoordination, ataxia Vomitting, dizziness Imbalance, fatigue Imbalance, ataxia Hemiplegia, ataxia Ataxia Hemisphere Right Right Right Left Left Left MR findings Topography Inferior aspect of cerebellar hemisphere Inferior aspect of cerebellar hemisphere Inferior aspect of cerebellar hemisphere Inferior aspect of cerebellar hemisphere Inferior aspect of cerebellar hemisphere Inferior aspect of cerebellar hemisphere Signal void lesions ++ + ++ + + +++ T1 SI Low Low Low Low Low Low T2 SI High High High High High High Gd-enhancement Peripheral Peripheral Peripheral Peripheral Peripheral Peripheral Angiographic findings ICA feeders No No No No No C5 branch ECA feeders Occipital a., ascending pharyngeal a. None Occipital a., ascending pharyngeal a. Occipital a. Occipital a. Occipital a., ascending pharyngeal a. VA feeders Artery of falx cerebelli, meningeal artery of cerebellar fossa Artery of falx cerebelli Artery of falx cerebelli, meningeal artery of cerebellar fossa Artery of falx cerebelli Meningeal artery of cerebellar fossa Meningeal artery of cerebellar fossa Venous drainage Inferior hemispheric vein Inferior hemispheric vein Inferior vermian vein to inferior hemispheric vein Inferior hemispheric vein Inferior hemispheric vein Inferior vermian vein to inferior hemispheric vein Notes.—+ indicates few; ++, prominent; +++, significant; T1, T1-weighted images; T2, T2-weighted images; SI, signal intensity; Gd, gadolinium-enhanced T1-weighted images; ICA, internal carotid artery; ECA, external carotid artery; VA, vertebral artery; a, artery.
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