Dural arteriovenous fistula presenting with recurrent focal status epilepticus and lateralised periodic epileptiform discharges

Neurol Sci. 2024 Apr;45(4):1741-1748. doi: 10.1007/s10072-024-07325-x. Epub 2024 Jan 19.

Abstract

Background: Dural arteriovenous fistulae (dAVF) are relatively infrequently encountered, and status epilepticus (SE) and lateralised periodic discharges (LPDs) on electroencephalography (EEG) have only rarely been associated with these arteriovenous malformations.

Methods: We present a patient with recurrent presentations with focal SE, aphasia and other focal deficits of cortical function and ictal and peri-ictal LPDs on serial EEG, who was shown to have a left hemispheric dAVF associated with left transverse and sigmoid sinus thrombosis. Seizures proved refractory to four anti-seizure medications but became more amenable to control after successful embolisation of the dAVF, with subsequent resolution of the focal cortical deficits. We discuss the co-occurrence of SE and LPDs with dAVF and review previously reported cases with this rare association.

Conclusions: Our report supports a causative relationship between dAVF and focal SE, manifesting as ictal LPDs on EEG, and highlights the importance of active dAVF management in achieving seizure control. The relatively good patient outcome contrasts to the few similar case reports. Whilst rare, it is important to consider dAVF as a potentially treatable condition underlying new-onset seizures, including SE.

Keywords: Aphasia; Dural arteriovenous fistula; Lateralised periodic discharges; Seizures; Status epilepticus.

Publication types

  • Case Reports

MeSH terms

  • Central Nervous System Vascular Malformations* / complications
  • Central Nervous System Vascular Malformations* / diagnostic imaging
  • Central Nervous System Vascular Malformations* / therapy
  • Cranial Sinuses
  • Electroencephalography
  • Embolization, Therapeutic*
  • Humans
  • Status Epilepticus* / diagnosis
  • Status Epilepticus* / etiology
  • Status Epilepticus* / therapy