The patient, a 20-day-old male, was admitted due to respiratory distress that had persisted for 20 days after birth. The main clinical manifestations included gradually worsening respiratory distress and edema. The patient received treatment including mechanical ventilation and diuretics. Echocardiography indicated cardiomegaly, pulmonary hypertension, and heart failure. A comprehensive systemic examination revealed a significant blowing vascular murmur upon auscultation over the anterior fontanelle and bilateral temporal regions. Further imaging studies including cranial magnetic resonance imaging, magnetic resonance angiography, and magnetic resonance venography showed marked dilation of the superior sagittal sinus, transverse sinus, and sigmoid sinus, leading to a definitive diagnosis of dural arteriovenous fistula. After a multidisciplinary consultation, the patient underwent cerebral angiography and partial embolization of the left parietal arteriovenous fistula. Postoperatively, the patient was treated with positive inotropes, diuretics, and fluid restriction. Ultimately, the patient was weaned off the ventilator and discharged in improved condition. This article reports a case of neonatal dural arteriovenous fistula presenting with respiratory distress and discusses the multidisciplinary approach to managing this condition, which aids in early disease recognition and guides clinical decision-making.
Key words
Dural arteriovenous fistula /
Respiratory distress /
Heart failure /
Pulmonary hypertension /
Neonate
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
1 Lee SK, Hetts SW, Halbach V, et al. Standard and guidelines: intracranial dural arteriovenous shunts[J]. J Neurointerv Surg, 2017, 9(5): 516-523. PMID: 26614491. DOI: 10.1136/neurintsurg-2015-012116.
2 Kincaid PK, Duckwiler GR, Gobin YP, et al. Dural arteriovenous fistula in children: endovascular treatment and outcomes in seven cases[J]. AJNR Am J Neuroradiol, 2001, 22(6): 1217-1225. PMID: 11415924. PMCID: PMC7974771.
3 Farb RI, Kim JK, Willinsky RA, et al. Spinal dural arteriovenous fistula localization with a technique of first-pass gadolinium-enhanced MR angiography: initial experience[J]. Radiology, 2002, 222(3): 843-850. PMID: 11867811. DOI: 10.1148/radiol.2223010826.
4 Kwon BJ, Han MH, Kang HS, et al. MR imaging findings of intracranial dural arteriovenous fistulas: relations with venous drainage patterns[J]. AJNR Am J Neuroradiol, 2005, 26(10): 2500-2507. PMID: 16286391. PMCID: PMC7976221.
5 叶鸿瑁. 新生儿心力衰竭的常见病因、诊断及治疗[J]. 实用儿科临床杂志, 2006, 21(18): 1204-1207. DOI: 10.3969/j.issn.1003-515X.2006.18.003.
6 Masarone D, Valente F, Rubino M, et al. Pediatric heart failure: a practical guide to diagnosis and management[J]. Pediatr Neonatol, 2017, 58(4): 303-312. PMID: 28279666. DOI: 10.1016/j.pedneo.2017.01.001.
7 Lasjaunias P, Magufis G, Goulao A, et al. Anatomoclinical aspects of dural arteriovenous shunts in children. Review of 29 cases[J]. Interv Neuroradiol, 1996, 2(3): 179-191. PMID: 20682095. DOI: 10.1177/159101999600200303.
8 McConnell KA, Tjoumakaris SI, Allen J, et al. Neuroendovascular management of dural arteriovenous malformations[J]. Neurosurg Clin N Am, 2009, 20(4): 431-439. PMID: 19853802. DOI: 10.1016/j.nec.2009.07.014.
9 Vougioukas VI, Coulin CJ, Shah M, et al. Benefits and limitations of image guidance in the surgical treatment of intracranial dural arteriovenous fistulas[J]. Acta Neurochir (Wien), 2006, 148(2): 145-153. PMID: 16322909. DOI: 10.1007/s00701-005-0656-6.
PDF(700 KB)
