Abstract
BACKGROUND AND PURPOSE: The pseudophlebitic pattern is an increasingly recognized angiographic manifestation of chronic venous congestion in the setting of a cranial dural arteriovenous fistula. We sought to study the clinical and radiologic manifestations of patients with the pseudophlebitic pattern. MATERIALS AND METHODS: We retrospectively reviewed a cohort of patients with dural arteriovenous fistulas evaluated at our institution from 2008 to 2020. Angiograms were reviewed to classify dural arteriovenous fistulas and document the presence or absence of a pseudophlebitic pattern, defined as the presence of serpiginous and tortuous collateral, bridging, and cortical veins with an associated delay in circulation time of the normal brain. We then studied the association between the pseudophlebitic pattern and clinical presentation and MR imaging findings. RESULTS: Two hundred one patients were included. Patients with a pseudophlebitic pattern had more hemorrhage (22.8% versus 8.4%, P = .005), gait changes and ataxia (6.0% versus 0.0%, P = 0.002), cognitive changes (6.9% versus 1.4%, P = .04), and seizures (8.6% versus 2.1%, P = .03). On MR imaging, the pseudophlebitic pattern was associated with higher rates of cerebral edema (70.9% versus 2.9%, P < .0001), chronic hemosiderin deposition and microhemorrhage (17.3% versus 2.2%, P = .0002), and dilated transmedullary veins (47.1% versus 0.0%, P < .0001). When we considered only patients with malignant fistulas, there was no difference in hemorrhage at presentation between the 2 groups (22.6% versus 22.8%, P = .99). Patients with a pseudophlebitic pattern did have higher rates of nonhemorrhagic neurologic deficits (24.1% versus 9.4%, P = .03). CONCLUSIONS: The pseudophlebitic pattern was associated with high rates of brain parenchymal changes and neurologic symptoms in this cohort of patients with dural arteriovenous fistulas.