A 71 year old male presented with 1-year history of ocular symptoms (diplopia, proptosis, episcleral congestion).
Case contributed by –
Department of Imaging Sciences and Intervention Radiology, SCTIMST, Trivandrum (from ISNR 2020 online quiz)
Final diagnosis – hypoglossal (anterior condylar confluence-acc) dural AV fistula with retrograde (cavernous sinus) drainage.
- Rare posterior fossa dural AV fistula.
- Fistula is seen between ECA (ascending pharyngeal arteries) and anterior condylar vein in the hypoglossal canal
- It retrogradely drains into cavernous sinus through inferior petrosal sinus and manifests like CCF
- ASL can be useful to identify the fistula by demonstrating arterial signal in the veins (cavernous in our case).
- Treatment: Surgery or embolization.