Cognitive profiles associated with intracranial dural arteriovenous fistula

摘要

SIR—There are a number of case studies and small casenseries of intracranial dural arteriovenous fistula (DAVF) associatednwith cognitive impairment sufficient to amount to andementia syndrome, with resolution of cognitive deficits followingndefinitive treatment (surgical, endovascular) of thenfistula [1–19]. Thus intracranial DAVF is recognised as anrare cause of reversible vascular dementia, through a presumednmechanism of intracerebral venous hypertension.nHowever, accounts of the precise neuropsychological deficitsnin these patients and serial documentation of cognitivenfunction are largely lacking, most reports focusing on thenneuroradiology of the vascular anatomy and endovascularnintervention. This may be due in part to the necessity fornprompt therapeutic intervention when there is acute neurologicalndeterioration [5], although at least some intracranialnDAVF cases are associated with slowly progressive cognitivendecline sufficient to suggest an initial differential diagnosisnof neurodegenerative dementia [8, 9, 15, 16]. The label ofn‘thalamic dementia’ has been used on occasion, based largelynon neuroimaging findings of bilateral thalamic involvementn[10, 17, 18].nOur experience with three cases of intracranial DAVFn[20] has included serial monitoring of cognitive function, eithernwith formal neuropsychological assessment or thenAddenbrooke's Cognitive Examination (ACE) [21], a ‘bedside’ntest which incorporates the Mini-Mental StatenExamination (MMSE) [22] and with which we have extensivenexperience [23]. As the clinical and neuroradiologicalndetails of these cases have been previously reported, onlynthe cognitive findings are given here.