Sudden severe chest pain: thoracic dural arteriovenous fistula aneurysm rupture with intracranial subarachnoid haemorrhage

Singapore Med J. 2010 Jul;51(7):e114-7.


Spinal perimedullary arteriovenous fistula (AVF) or dural arteriovenous fistula (DAVF) presenting as intracranial subarachnoid haemorrhage (SAH) is uncommon. A total of 16 cases have been reported to date. A majority of the reports described cervical spinal DAVF, while two other case reports described intracranial SAH secondary to lumbar and thoracic DAVF, respectively. We report a 61-year-old Chinese man with intracranial SAH secondary to thoracic DAVF aneurysm, who presented with sudden, severe chest pain, initially suggestive of aortic dissection/acute myocardial infarction. However, a careful examination of the history and physical signs, followed by appropriate and timely investigations enabled effective treatment to be administered promptly with a good outcome. This serves to illustrate the importance of investigating the entire cerebrospinal system when neurological symptoms and clinical signs suggest extracranial primary pathology.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adult
  • Aneurysm, Ruptured / complications
  • Aneurysm, Ruptured / diagnosis*
  • Aneurysm, Ruptured / therapy
  • Central Nervous System Vascular Malformations / complications
  • Central Nervous System Vascular Malformations / diagnosis*
  • Central Nervous System Vascular Malformations / therapy
  • Chest Pain / diagnosis
  • Chest Pain / etiology*
  • Chest Pain / therapy
  • Embolization, Therapeutic / methods*
  • Fibrin Tissue Adhesive / therapeutic use
  • Follow-Up Studies
  • Humans
  • Intracranial Aneurysm / complications
  • Intracranial Aneurysm / diagnosis*
  • Intracranial Aneurysm / therapy
  • Magnetic Resonance Angiography
  • Male
  • Rare Diseases
  • Risk Assessment
  • Severity of Illness Index
  • Subarachnoid Hemorrhage / complications
  • Subarachnoid Hemorrhage / diagnosis*
  • Subarachnoid Hemorrhage / therapy
  • Tomography, X-Ray Computed
  • Treatment Outcome


  • Fibrin Tissue Adhesive