ABSTRACT
Dural arteriovenous fistula (DAVF) is rarely associated with parkinsonism. A 52-year-old woman presented with a rare case of DAVF manifesting as parkinsonism and subsequently akinetic mutism. She showed dramatic recovery after endovascular treatment. We also review 10 published reports of DAVF presenting with parkinsonism. The clinical features of these cases at presentation was more closely compatible with lower body parkinsonism or vascular parkinsonism rather than Parkinson's disease. Most lesions are located at the transverse-sigmoid sinus (TSS) with venous reflux into the straight sinus with probable venous congestion of the basal ganglia. Most importantly, parkinsonism due to TSS DAVF is reversible if embolization is achieved successfully.
Subject(s)
Central Nervous System Vascular Malformations/complications , Parkinsonian Disorders/etiology , Transverse Sinuses , Central Nervous System Vascular Malformations/diagnosis , Central Nervous System Vascular Malformations/therapy , Cerebral Angiography , Cranial Sinuses/pathology , Diagnosis, Differential , Diffusion Magnetic Resonance Imaging , Embolization, Therapeutic , Female , Follow-Up Studies , Humans , Magnetic Resonance Imaging , Middle Aged , Neurologic Examination , Parkinsonian Disorders/diagnosis , Parkinsonian Disorders/therapy , Tomography, X-Ray Computed , Transverse Sinuses/abnormalities , Transverse Sinuses/pathologyABSTRACT
OBJECTIVE: To compare clinical findings in patients with Behçet's disease (BD) seen in 2 different decades (1980s and 1990s) to determine if there has been a shift toward the appearance of less severe disease. DESIGN: Retrospective, comparative case series. PARTICIPANTS: Two hundred forty patients with uveitis caused by BD who had their first visit and at least a 4-month follow-up at the uveitis clinic of University of Tokyo Hospital between January 1980 and December 1999 were enrolled. METHODS: Patients were divided into 2 groups according to the date of the first visit. The clinical profiles were then compared between the 1980s group (133 patients, observed for 33.5+/-26.4 months) and the 1990s group (107 patients, observed for 46.9+/-32.6 months). MAIN OUTCOME MEASURES: Number of ocular attacks per year, visual outcomes, and the percentage of patients who had cyclosporine or cyclophosphamide therapy. RESULTS: Age of onset, type of inflammation, incidence of secondary glaucoma, and surgical history of glaucoma and cataract did not differ between the 1980s and the 1990s. Conversely, in patients in the 1990s, the number of ocular attacks per year and the percentage of patients with cyclosporine or cyclophosphamide therapy decreased significantly. Furthermore, the percentage of eyes with good visual acuity (VA) (?20/30) increased, and the percentage of eyes with poor VA (<20/200) decreased significantly at both the first and the last examinations. There was a trend for less bilateral disease and fewer genital ulcers in the 1990s as well. CONCLUSIONS: Through a study of Japanese patients, we confirmed that the clinical outcomes of BD, especially judging by the number of ocular attacks per year and VA, indeed improved during the 1990s.
