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Pulsatile tinnitus and intracranial vascular murmur About 70% of patients have a pulsatile intracranial vascular murmur, which can be localized to the lesion or spread over the entire head. 2. headache About 50% have headache, which may be localized to the lesion or spread throughout the head, and may be persistent, pulsating and severe, aggravated by activity, postural changes or high blood pressure. 3.
Intracranial hemorrhage May present as subarachnoid hemorrhage, subdural hemorrhage or hematoma, or intracerebral hemorrhage or hematoma. Most authors believe that it is caused by rupture of a thick tortuous thin-walled draining vein and is not related to the fistula itself. Intracranial hemorrhage may be followed by a corresponding occupying effect. (1) The presence of an arteriovenous fistula causes direct perfusion of arterial blood into the dural venous sinus, which transmits unabated arterial pressure to the venous sinus causing a continuous increase in pressure in the venous sinus, blocking intracranial venous return and impairing cerebral crest fluid absorption; (2) venous sinus thrombosis, which affects intracranial venous return and cerebral crest fluid absorption; (3) a tumor-like dilatation of the draining vein, which may result in a dural (3) subdural venous lake may occur, producing an occupying effect. 5.
Central nervous system symptoms may include mental confusion, dementia, limb weakness, stroke, hydrocephalus and epilepsy. Diplopia, loss of vision and unstable walking are also common symptoms, which may be due to mechanical compression of dilated veins or sinuses, or intravenous hypertension with obstructed reflux, causing increased intracranial pressure and direct return of arterial blood to the veins, resulting in local cerebral tissue ischemia and hypoxia.