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Neurology 2002;58:1521-1524
© 2002 American Academy of Neurology

Bilateral orbital signs predict cortical venous drainage in cavernous sinus dural AVMs

H. Stiebel-Kalish, MD, A. Setton, MD, A. Berenstein, MD, Y. Kalish, MA, Y. Nimii, MD and M. J. Kupersmith, MD

From the Neuro-Ophthalmology Service (Dr. Stiebel-Kalish), Rabin Medical Center, Petah Tikva, Israel; Endovascular Service (Drs. Setton, Berenstein, and Nimii) and Neuro-Ophthalmology Service, Institute of Neurology and Neurosurgery (Dr. Kupersmith), Beth Israel Medical Center, and New York Eye and Ear Infirmary and NYU Medical Center (Dr. Kupersmith), New York, NY; and Department of Psychology (Y. Kalish), University of Melbourne, Australia.

Address correspondence and reprint requests to Dr. Hadas Stiebel-Kalish, Neuro-Ophthalmology Service, Department of Ophthalmology, Rabin Medical Center, Petah Tikva 49100, Israel; e-mail: kalisheh{at}hotmail.com

Background: Most cavernous sinus dural arteriovenous malformations (CSdAVM) have a benign clinical course. Those CSdAVM that drain into cortical veins have an increased risk for neurologic complications.

Objective: To find whether a specific clinical sign predicts cortical venous drainage (CVD) in CSdAVM.

Methods: The records of 118 patients with CSdAVM were evaluated for the clinical features of the disorder and tested for predictive value of CVD demonstrated angiographically or suggested by MRI using logistic regression and odds ratio (OR) analysis.

Results: Clinical signs that predicted the presence of CVD included bilateral orbital signs (p = 0.004, OR = 23.84) and presence of a postauricular bruit (p = 0.035, OR = 23.8). No other clinical sign predicted the presence of CVD, including extraocular muscle dysfunction, abducens or oculomotor dysfunction, increased intraocular pressure, venous stasis retinopathy, choroidal effusion, optic neuropathy, subjective bruit, and objective orbital bruit.

Conclusion: Patients who present with or develop bilateral orbital congestion should be recognized as being at increased risk for CVD.




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Localized Congestive Venous Encephalopathy Associated with Cavernous Dural Arteriovenous Malformation
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[Abstract] [Full Text] [PDF]


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