Galeal necrosis due to arteriovenous fistula embolization: Case report
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Abstract
A 41-year-old male who was admitted to the emergency department with holocranial headache and vertiginous sensation. Two days prior to admission, the headache had increased in intensity, and blurred vision was persistent with no response to analgesics. The patient was admitted with a glasgow of 4/15 (ocular response, 1 point; verbal response, 1 point; motor response, 2 points), mydriatic pupils of 4 mm, unreactive, and requiring invasive mechanical ventilation. Given these findings, we decided to perform simple skull tomography in which right frontal, parietal, and temporal subdural hematomas were evident, with mass effect and subfalcine and transtentorial herniation, diffuse cerebral edema, and midline deviation. Angiotomography of the cranial vessels demonstrated a vascular malformation with apparent arterial filling, dependent on the posterior circulation. One month later, the patient was referred from the outpatient clinic because in the postoperative control, a necrotic lesion measuring approximately 10 x 4 cm was observed in the right parieto-occipital region, which increased with respect to his discharge from his first hospitalization and with evidence of active secretion. The patient underwent debridement and wound washing. He was discharged without any new neurological alterations.
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Embolization, arteriovenous fístula, coils
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