Abstract
Background/Objectives Cerebral dural arteriovenous fistulas (dAVF) may be asymptomatic, or present with acute or slowly evolving neurological deficit. Occasionally, cerebral dAVF may mimic an acute stroke syndrome, increasing diagnostic uncertainty, and requiring early magnetic resonance imaging (MRI) and digital subtraction angiography (DSA).
Methods A case report detailing a patient presenting with acute onset nausea, vomiting, ataxia, and dysarthria.
Results A 69-year-old male was transferred to a tertiary hospital for concern for acute stroke following sudden onset vomiting, dysarthria, right arm weakness, and unsteady gait. Examination performed within 12 hours of symptom onset showed right upper and lower limb ataxia without weakness, dysarthria, bilateral nystagmus, and tongue weakness. His National Institute of Health Stroke Scale was 4. An initial computed tomography scan was unrevealing for acute or established ischaemia, or haemorrhage. However, abnormal clustering of vessels in the posterior fossa supported the presence of an arteriovenous malformation. Subsequent MRI of the brain demonstrated venous congestion of the upper cervical cord and lower brainstem. He proceeded to DSA confirming a high-grade (Borden III) cerebral dAVF with arterial inflow from bilateral posterior meningeal arteries and bilateral occipital arteries. There was venous congestion of the cerebellar draining veins, occipital sinus and longitudinal spinal veins. Embolisation of the dAVF was performed successfully using Onyx liquid embolic agent, and the patient’s neurology subsequently improved.
Conclusion This case demonstrates that cerebral dAVFs can manifest in a manner that mimics acute stroke, with symptoms secondary to venous congestion. The diagnostic value of early MRI and DSA is demonstrated.
