Résumé
Objective:To improve awareness about infratentorial dural arteriovenous fistula (DAVF).Methods:Three cases of DAVF in the First Affiliated Hospital of Soochow University from September 2017 to September 2019 were retrospectively analyzed in terms of clinical features, cerebrospinal fluid (CSF) analysis, brain imaging and treatment, and followed up through telephone call.Results:Case 1: A 43-year-old woman, in chronic but acute aggravated course, presented with weakness of both lower limbs and urination and defecation dysfunction. Brain magnetic resonance imaging (MRI) revealed abnormal signal in medulla. CSF analysis demonstrated aquaporin-4 antibodies positive. Misdiagnosed as neuromyelitis optica spectrum disorders, the treatment was poor. Then digital subtraction angiography (DSA) showed DAVF at the left infratentorial area, and endovascular treatment was operated. Relapse was not observed in two-year follow up. Case 2: A 57-year-old woman, in chronic progressive course, mainly manifested as memory loss, but progressed with dysphagia, fever, coma. Treatment as “central nervous infection” was poor. Then DSA showed DAVF at the bilateral transverse-sigmoid sinus area, and endovascular treatment was operated with embolized partial fistulas. The patient died from lung infection within two months. Case 3: A 52-year-old man, in subacute course, was treated in the Gastroenterology Department with clinical manifestion of stubborn nausea and vomiting. Brain MRI revealed abnormal signal in medulla, with prominent vessel flow voids nearby. Then DSA showed DAVF at the craniocervical junction, and endovascular treatment was operated. Relapse was not observed in six-month follow up.Conclusions:DAVF has a variety of clinical manifestations, and infratentorial DAVF can manifest as acute neurological dysfunction involving the brain stem, cerebellum, spinal cord, which may be easily misdiagnosed. When brain MRI showed intracranial abnormal signal, the possibility of DAVF should be considered. DSA remains the gold standard to diagnose DAVF. Endovascular embolization is the main treatment of infratentorial DAVF at present. Prognosis depends on clinical presentation and fistula classification.
Résumé
OBJECTIVE@#To investigate the correlation between psychological disorder and vestibular dysfunction in patients suffering from peripheral vertigo.@*METHOD@#Retrospective review of 17 peripheral vertiginous patients with intractable Meniere's disease recruited from the EENT hospital whom underwent intratympanic gentamicin injection. Hospital anxiety and depression scale, self-rating anxiety scale, self-rating depression scale, symptom checklist-90 were used in this study. Pre- and postoperative scores where compared.@*RESULT@#The vertigo control rate of 17 patients reached 88%, with hearing impairment noted only in 17.6% of the patients. 33.3% of the preoperative tinnitus patients and 76.9% of the preoperative aural fullness patients had their symptoms relieved respectively. The outcomes of hospital anxiety and depression scale, self-rating anxiety scale, self-rating depression scale, symptom checklist-90 are significantly greater in vertiginous group than that in normal controls (P 0.05).@*CONCLUSION@#Significant differences were noted between peripheral vertiginous patients and normal controls in psychiatric questionnaires, suggesting that psychological dysfunction may contribute to the vertigo attack.