Successful Treatment of Right Parietal Haematoma Secondary

A 44-year-old young hypertensive male visited Max Smart Super Speciality Hospital, Saket, with complaints of headache, giddiness and weakness in the left upper limb since one day. On examination, the patient was sleepy but arousable and was following simple commands. GCS was E4V5M6, left upper limb power Grade 4, rest all limbs Grade 5, left-sided sensory inattention, agraphia, and astereognosis. MRI of the brain revealed a large (5.7 x 4 x 4.2 cm) right parietal haematoma, with mass effect and midline shift. Cerebral DSA was done, which was suggestive of posterior falcine Dural Arteriovenous Fistulas (DAVF), with feeders from bilateral occipital arteries and drainage into dilated cortical veins. Cognard Grade 4 Dural Arteriovenous Fistulas (DAVF) was diagnosed.

The patient was planned for embolisation, followed by craniotomy and evacuation of the haematoma.

Complete occlusion of DAVF was achieved by embolisation, and right parietal craniotomy and complete hematoma evacuation was also done. The patient was kept in ICU for one day and later shifted to the room. Agraphia, astereognosis and left limb weakness also improved. On the 5 th day of surgery, the patient was discharged.