Intracranial Venous Hypertension Induced by Superior Vena Cava Syndrome Mimicking Cavernous Dural Arteriovenous Fistula.

Abstract

Known facts are that a long period of central catheterization or hemodialysis causes central venous occlusion or stenosis and its further development brings about superior vena cava syndrome. Major symptoms of superior vena cava syndrome include venous congestion caused by the occlusion or stenosis of the central vein in the sites of the head, face, neck, and upper extremity. Clinical manifestations of superior vena cava syndrome are less likely to cause intracranial hypertension, and intracranial venous hypertension does not appear to be a clinical symptom of cavernous sinus-dural arteriovenous fistula. A 35-year-old female patient visited our hospital with chief complaints of a 2-week-old headache, chemosis, pulsatile and exophthalmos and the deteriorating ptosis in the right eye. The patient has been on continuous hemodialysis since diagnosis of renal failure due to diabetes for 20 years. Magnetic resonance images led us to a strong suspicion of cavernous sinus-dural arteriovenous fistula. However, an additionally performed digital subtraction angiogram led us to the diagnosis of superior vena cava syndrome of severe stenosis in both brachiocephalic veins. Balloon angioplasty was performed to the narrowed right-side brachiocephalic vein. No more intracranial venous reflux was to be seen in the postballoon angiogram. In our case, the clinical manifestations of superior vena cava syndrome seemed to be cavernous sinus-dural arteriovenous fistula and symptoms disappeared when resolving central vein stenosis. We report a case of superior vena cava syndrome with atypical clinical features.