Neurointervention.  2017 Sep;12(2):125-129. 10.5469/neuroint.2017.12.2.125.

Dementia and Parkinsonism-a Rare Presentation of Intracranial Dural Arteriovenous Fistulae

• Gopinath M
• Nagesh C
• Santhosh K
• Jayadevan

• KMID: 2389506
• DOI: http://doi.org/10.5469/neuroint.2017.12.2.125

Abstract

Intracranial dural arteriovenous fistulae (DAVF) are acquired fistulous communications between dural arterial branches and dural venous sinuses or cortical veins with the nidus located within the leaflets of the duramater. Dementia and Parkinsonism are amongst the rarest of clinical presentations in DAVFs and are important to diagnose early, being treatable with timely intervention. We present an interesting case of a patient who presented with rapidly progressive dementia and features of parkinsonism who was diagnosed to have extensive DAVF and made remarkable recovery after embolization of the fistulae.

Keyword

Dural arteriovenous fistula; Embolization; Dementia; Parkinsonism

MeSH Terms

Central Nervous System Vascular Malformations*
Dementia*
Fistula
Humans
Parkinsonian Disorders
Veins

Figure

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  Fig. 1 Axial T2-weighted images reveal tortuous flow voids in cisterns and sylvian fissure with prominent enlarged torcula and bilateral, diffuse white matter hyperintensities.

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  Fig. 2 DSA images reveal torcular and superior sagittal sinus DAVFs with arterial feeders from (A) internal carotid artery via marginal tentorial artery, from external carotid artery via (B) occipital and (C) middle meningeal branches.

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  Fig. 3 Follow-up angiograms (A, B) show residual torcular DAVF with arterial supply from occipital artery. (C) Post-embolization angiogram shows obliteration of shunt at torcula. (D) Post-embolization status with squid casts in situ in superior sagittal sinus and torcula.

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  Fig. 4 Follow-up, axial T2-weighted images (A-C) show significant resolution of T2 white matter hyperintensities that were seen in the initial pretreatment MRI.

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