Multiple dural arteriovenous fistulae and SARS CoV-2, a lethal combination

Abstract

Introduction: Dural arteriovenous fistulas are abnormal communications between the arterial and dural sinus vessels or the cortical veins. Multiple dural arteriovenous fistulae have an incidence rate of 6-9%. Their pathophysiology is poorly understood, although there is a consensus on three theories for their formation. The systemic infection caused by SARS-CoV-2 in its severe presentations is associated with a pro-inflammatory state that represents an ideal condition for complications of pre-existing cerebrovascular diseases. Digital subtraction angiography is considered the gold standard to understand the architecture of this lesion. Case Presentation: The patient was a 49-year-old male with a history of multiple head trauma, a 20-year history of tobacco use, tinnitus, and gradual deterioration of higher mental functions. On admission, he presented respiratory distress and was dependent on oxygen. Conclusion: This case presents a bleak picture of the overlap between two devastating diseases as a clear example of the direct and collateral damage of the SARS-CoV-2 pandemic. Coronavirus disease in 2019 does not exclude a previous underlying pathology.

Keywords

• Multiple dural arteriovenous fistulae. SARS-CoV-2. Dural venous sinuses. Cortical veins.