Correspondence Address:
Dr. Jamir Pitton Rissardo
Rua Roraima, Santa Maria, Rio Grande do Sul
Brazil

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Dear Editor,

We read the article entitled, “Unusual Cause of Seizure” on the esteemed “Libyan Journal of Medical Sciences” with great interest. Elhassan Eltahir et al. reported a case of an elderly male presenting with seizure. A cranial magnetic resonance angiography revealed the superior sagittal sinus dural arteriovenous fistula. He underwent a successful catheter embolization of the fistula. Antiepileptic drugs were started, and the subject was seizure-free.[1]

Cranial dural arteriovenous fistulas are abnormal vascular malformations of the cranial dura, which involve connections between meningeal arteries draining into veins adjacent to dural venous sinuses.[2] The etiological factors of this shunt are traumatic brain injury, surgery, and sinus thrombosis. Thrombosis appears to be the most common predisposing factor.[1] In this context, there are some classification systems based on angiographic findings. The first grading method was proposed by Djindjian and Merland.[2] Today, in clinical practice, we currently use Borden and Cognard classifications. These scales are important because they can estimate the annual hemorrhagic risk of vascular malformation.[3] Here, we would like to provide [Table 1] and [Figure 1] to better understand these systems.[2],[3],[4]{Table 1}{Figure 1}

The majority of these fistulas are believed to be asymptomatic due to angiographic epidemiological studies;[2] however, when they are symptomatic, some features are pulsatile tinnitus, occipital bruit, visual impairment, and papilledema.[4] An interesting fact is that some individuals present with headache due to the inflammation of dural pain fibers, which based on this sole symptom is difficult to diagnosis cranial dural arteriovenous fistulas in the clinical practice and needs to have high clinical suspicion;[3] the pain is characteristic continuous with some lateralization but can be bilateral.[2]

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References