The importance of experienced computer tomographic reading in the setting of telemedical stroke management: A complex cerebral dural arteriovenous fistula as an atypical cause of coma

摘要

Specialized stroke expertise is made available to a larger population by telemedical stroke networks. The Stroke Eastern Saxony SOS network [Schlaganfall Ost-Sachsen-(SOS)-NET] provides telemedical consultation for patients with acute ischemic stroke. During the consultation stroke neurologists perform standardized evaluation of cerebral computed tomography (CT) scans including quantification of early ischemic changes. To illustrate the benefits of a comprehensive stroke network, the case of a patient with an atypical cause of right-sided hemiparesis rapidly progressing to tetraparesis and coma is presented. The first putative diagnosis was brains-tem stroke. Systemic thrombolysis was considered but quickly abandoned after the stroke neurologist discovered an unusual perimesencephalic vessel on the initial CT.