Journal of neuroendovascular therapy · 2025
Unusual Development of Central Diabetes Insipidus after Endovascular Treatment for a Medial Tentorial Dural Arteriovenous Fistula.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Oka Yuta, Horio Yoshinobu, Matsuishi Munenari, Suzuki Koichiro, Takeyama Ryuhei, Yoshinaga Shintaro, Maki Kei, Nakazato Mio, Takemoto Koichiro, Abe Hiroshi
Аннотация
OBJECTIVE: Medial tentorial dural arteriovenous fistulas (DAVFs) are rare lesions that may cause intracranial hemorrhage or non-hemorrhagic symptoms due to venous congestion from retrograde deep venous drainage. We report a case of a medial tentorial DAVF presenting with cognitive decline and impaired consciousness, successfully treated with transvenous embolization (TVE) and straight sinus angioplasty, and complicated postoperatively by central diabetes insipidus (CDI).
CASE PRESENTATION: A 55-year-old man with diabetes mellitus presented with cognitive decline, disorientation, aphasia, and motor impairment without limb paralysis. CT revealed bilateral thalamic hyperdensities, and MRI showed thalamic and medial occipital hypointensities. CT venography demonstrated straight sinus occlusion. Angiography identified a tentorial DAVF fed by the posterior meningeal and tentorial arteries, draining into the superior vermian vein (Borden III, Cognard III). On day 3, TVE and straight sinus angioplasty achieved complete shunt obliteration. Postoperatively, serum sodium increased from 157 mEq/L on day 1 to 164 mEq/L on day 2, accompanied by thirst, polydipsia, and polyuria. Correction of hyperglycemia did not improve the symptoms. The absence of urine output reduction during water restriction and marked improvement after I-deamino-8-D-arginine vasopressin (DDAVP) confirmed CDI. DDAVP was tapered from day 58 and stopped on day 68 without recurrence. The patient was discharged on day 72.
CONCLUSION: To our knowledge, this is the first report of CDI after treatment of a medial tentorial DAVF. In patients with deep venous congestion, similar complications may occur. Careful postoperative monitoring of urine output and electrolytes is essential for early recognition and management.
CASE PRESENTATION: A 55-year-old man with diabetes mellitus presented with cognitive decline, disorientation, aphasia, and motor impairment without limb paralysis. CT revealed bilateral thalamic hyperdensities, and MRI showed thalamic and medial occipital hypointensities. CT venography demonstrated straight sinus occlusion. Angiography identified a tentorial DAVF fed by the posterior meningeal and tentorial arteries, draining into the superior vermian vein (Borden III, Cognard III). On day 3, TVE and straight sinus angioplasty achieved complete shunt obliteration. Postoperatively, serum sodium increased from 157 mEq/L on day 1 to 164 mEq/L on day 2, accompanied by thirst, polydipsia, and polyuria. Correction of hyperglycemia did not improve the symptoms. The absence of urine output reduction during water restriction and marked improvement after I-deamino-8-D-arginine vasopressin (DDAVP) confirmed CDI. DDAVP was tapered from day 58 and stopped on day 68 without recurrence. The patient was discharged on day 72.
CONCLUSION: To our knowledge, this is the first report of CDI after treatment of a medial tentorial DAVF. In patients with deep venous congestion, similar complications may occur. Careful postoperative monitoring of urine output and electrolytes is essential for early recognition and management.