Epistaxis caused by a dural AV-fistula at the cribriform plate.

OBJECTIVES/HYPOTHESIS: A dural arteriovenous fistula (DAVF) with cortical venous reflux (CVR) is a dangerous neurovascular entity. A DAVF at the cribriform plate is typically silent until its inevitable presentation with intracranial hemorrhage.

CASE SUMMARY: A 67-year-old male presented with severe epistaxis. Following unsuccessful conventional measures and a surgical exploration, a catheter angiography showed a DAVF at the cribriform plate, with its nidus extending into the nasal cavity. The DAVF was treated via a small craniotomy.

CONCLUSION

In case of atypical or unexplained nosebleeds, the possibility of a DAVF or other neurovascular pathology should be excluded by MRI/MRA or catheter angiography.