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Dural Arteriovenous Fistula With Sinus Thrombosis and Venous Reflux Presenting as Parkinsonism

A Case Report

Chang, Chia-Wei MD*; Hung, Hung-Chang MD, PhD; Tsai, Jiao-I MD*; Lee, Po-Chang MD; Hung, Shih-Chang MD, DrPH§

doi: 10.1097/NRL.0000000000000235
Case Report/Case Series
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The occurrence of dural arteriovenous fistula (DAVF) is rare. The clinical manifestation varies and depends on the location and venous drainage pattern. We present a case of a 57-year-old man with a left transverse sinus DAVF along with sigmoid thrombosis, cortical venous reflux, and congestion, that initially presented as parkinsonism. The patient was alert and fully oriented; however, decreased facial expressions were noted. His left forearm showed rigidity and bradykinesia, and it was difficult for the patient to smoothly perform rapid alternating movement testing. His complaints about hearing a rhythmic bruit above the left ear, particularly when lying down, alerted the physician of the presence of vascular lesions. Magnetic resonance imaging and angiography confirmed the diagnosis of DAVF. The patient received a combined surgical and endovascular approach to permanently block the fistula blood flow. The motion and movement of his left upper limb improved after fistula embolization. Images at the 1-month follow-up showed a decrease in the volume of tortuous vessels, and the fistula was completely occluded.

Departments of *Neurology

Internal Medicine

Surgery

§Emergency Medicine, Nantou Hospital, Nantou, Taiwan

The authors declare no conflict of interest.

Correspondence to: Shih-Chang Hung, MD, DrPH, Department of Emergency Medicine, 478, Fuxing Road, Nantou Hospital, Nantou, 54062, Taiwan. E-mail: shihchan@gmail.com.

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