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

Laryngoscope. 2014 Nov;124(11):2476-7. doi: 10.1002/lary.24755. Epub 2014 Jun 10.

Abstract

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.

Keywords: Dural AV-fistula; anterior fossa; cortical venous reflux; epistaxis.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Central Nervous System Vascular Malformations / complications*
  • Central Nervous System Vascular Malformations / diagnostic imaging*
  • Central Nervous System Vascular Malformations / surgery
  • Craniotomy / methods
  • Emergency Service, Hospital
  • Epistaxis / etiology*
  • Epistaxis / physiopathology
  • Epistaxis / surgery*
  • Ethmoid Bone / surgery
  • Follow-Up Studies
  • Humans
  • Magnetic Resonance Angiography / methods
  • Male
  • Radiography
  • Risk Assessment
  • Severity of Illness Index
  • Treatment Outcome
  • Vascular Surgical Procedures / methods