Intracranial Venous Reflux Caused by Occlusion of the Brachiocephalic Vein Mimicking Dural Arteriovenous Fistula

Abstract

BACKGROUND: High signal intensity of cerebral venous sinuses on magnetic resonance angiography (MRA) indicates high flow of shunt from arterial blood, suggesting dural arteriovenous fistula (dAVF). Herein, we describe the cases of 2 patients with intracranial venous reflux caused by brachiocephalic vein occlusion (BVO) mimicking dAVF on MRA. CASE DESCRIPTION: Case 1 was a 71-year-old woman who had received arteriovenous graft (AVG) surgery for hemodialysis and presented with headache. MRA depicted high signal intensities in the left jugular vein, inferior petrosal sinus, and ophthalmic vein suggesting intracranial dAVF. However, cerebral angiography revealed intracranial venous reflux through the jugular vein caused by BVO. After balloon angioplasty with stenting for BVO, normal venous drainage was restored and her symptoms resolved. Case 2 was a 62-year-old woman who had received AVG for hemodialysis and was hospitalized due to seizure. MRA revealed high signal intensities of the left transverse-sigmoid sinus and jugular vein, and it was suspected that they were associated with BVO. She did not receive immediate intervention because of her septic condition. The patient ultimately died of fatal intracranial hemorrhage and subarachnoid hemorrhage. CONCLUSIONS: Central venous occlusion may occur in patients with end-stage renal disease who are receiving AVG for hemodialysis. Intracranial venous reflux resulting from BVO can induce various neurologic disorders including intracranial venous hypertension or hemorrhage. Prompt recognition and implementation of endovascular treatment can be beneficial in cases of symptomatic central venous occlusion.