Dural arteriovenous fistulas

"Dural arteriovenous fistulas are abnormal communications, within the dural leaflets, between meningeal arteries and dural venous sinuses and/or subarachnoid veins." They can present anywhere within the intracranial dura matter but most common locations are the cavernous sinus, cribriform plate, transverse sigmoid sinus, and tentorium. (Elhammady et al, 2017)

DAVFs may lead to rapidly progressive cognitive impairment, a potentially reversible dementia (Geschwind et al, 2016).

• Cases described have included presentation w/ headache, progressive confusion, and memory loss w/ rapid progressive over the course of 2 weeks to 12 months. Some developed seizures, gait instability, aphasia, facial palsy, or hemiparesis. A bruit was sometimes heard over the skull.
• Diagnosis
  • made by angiogram
  • MRI findings include high intensity in cerebral/cerebellar white matter w/ enlarged vessels over hemispheric surface or rarely basal ganglia hyperintensity.
• Treatment
  • embolization, surgery, or embolization and surgery have led to improvement.

References

Elhammady MS, Ambekar S, Heros RC. Epidemiology, clinical presentation, diagnostic evaluation, and prognosis of cerebral dural arteriovenous fistulas. Handb Clin Neurol. 143:99-105 (2017)

Geschwind MD. Rapidly progressive dementia. Continuum. Apr:22(2 Dementia):510-537 (2016). https://pubmed.ncbi.nlm.nih.gov/27042906/