22. European Stroke Conference 172 Interesting and challenging cases Ringing Ear after Cerebral Venous Sinus Thrombosis V.K. Sharma1, A, Ahmad2, C.K. Ong3, B.P.L. Chan4 National University of Singapore, Singapore, SINGAPORE1, National University Health Sys-tem, Singapore, SINGAPORE2, National University Health System, Singapore, SINGAPORE3, Na-tional University Health System, Singapore, SINGAPORE4 Background and aim- Intracranial dural arteriovenous fistula (DAVF) is an uncommon lesion. DVAFs are usually acquired, present later in life than cerebral arteriovenous malformations and usually remain clinically silent. We present the clinical and imaging findings of a patient who de-veloped pulsatile tinnitus in her left ear due to a DVAF, 9 months after an extensive cerebral venous sinus thrombosis. Case report- A 53 years old woman presented with pulsatile ‘hissing sounds’ in her left ear for about 2 weeks. The sounds were persistent and of mild intensity. She denied any hearing impairment, pain or discharge from the ear. She had suffered from an extensive cerebral venous sinus thrombosis about 9 months ago, involving the left transverse and sigmoid sinuses with extension into the ipsilat-eral internal jugular vein. Treatment with anticoagulant therapy had resulted in rapid and complete clinical recovery. Her current neurological examination was unremarkable. Examination of the ears, including hearing tests, did not reveal any abnormal findings. No new parenchymal lesions were noted on computed tomography of the brain. Digital subtraction angiography after a left external ca-rotid contrast injection revealed a Cognard type IIa left tentorial DAVF along the sigmoid sinus. Our patient refused any endovascular intervention. Her mild pulsatile tinnitus has not changed in severi-ty or character and she did not develop any new symptoms during past 16 months. Furthermore, no changes in the size or drainage patterns of the DVAF were noted on a recent catheter angiography. Conclusions- Venous hypertension is believed to open numerous microscopic vascular connections within the dura that may mature further into direct shunts between the arteries and veins. Pulsatile tinnitus may occur when a DVAF in the petrous temporal region drains into the larger sinuses like transverse or sigmoid sinus. DVAF should be considered as a possible diagnosis in patients with ear symptoms. 374 © 2013 S. Karger AG, Basel Scientific Programme 173 Interesting and challenging cases Visual and somatosensory phenomena following occipitotemporal damage due to cerebral ve-nous infarction – a case report B. Paradowski1, A. Loster-Niewinska2, E. Kowalczyk3 Department of Neurology, Wroclaw Medical University, Wroclaw, POLAND1, Department of Neurology, Wroclaw Medical University, Wroclaw, POLAND2, Department of Neurology, Wroclaw Medical University, Wroclaw, POLAND3 Background: Hemianopsia or quadrantanopsia is the most frequent clinical presentation of occipital or visual tract lesion. However, damage to the primary or secondary visual cortex can also manifest as visual hallucinations. It can present as elementary (photopsia) or complex phenomena. Photop-siae, consisting of bright lights (points, flashes, sparks) are more likely to appear with occipital pathologies, whereas complex hallucinations, defined as formed images of objects or persons, are combined with abnormalities of the occipitotemporal and occipitoparietal region. Case report: A 61-year-old Caucasian man was admitted to our clinic due to 2 weeks history of dai-ly headache. He was complaining of transient visual abnormalities, which he described as impaired ability to recognize faces, dark spots moving in the visual field and distorted contours of an objects. He gave up smoking 15 years ago and had no relevant medical history except for well-controlled hypertension. The neurological evaluations revealed minor left-side hemiparesis and balance dis-order. There was no evidence of visual field loss in the confrontation exam. The cerebral magnetic resonance imaging (MRI) demonstrated findings consistent with cerebral venous sinus thrombosis complicated by left-sided occipitotemporal hemorrhagic infarction. During his stay in the hospital, the patient started to experience more complex visual phenomena of waving of the ceiling, clouds which he could form and feel, reduction of a paper sheet size, nonexistent pack of cigarettes and, lastly, Pac-Man from the computer game eating a drip stand. The visual appearance lasted for about two weeks and disappeared spontaneously. Conclusion: Authors present a case of coexistence of simple and complex, visual and somatosensory parahallucinations and illusions in the course of rare cerebral venous infarction. The possible mech-anism involves irritation of cortical centers responsible for visual processing.
Karger_ESC London_2013
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