Bilateral Mirror Image Dural Arteriovenous Malformations Presenting with Aggressive Neurological Deterioration. Case report.

Abstract

Background: Multiple dural arteriovenous malformations occur rarely in the same individual. We describe a patient with bilateral, mirror image, dural arteriovenous malformations (DAVMs). This unusual case raises interesting questions regarding the origin of DAVMs. Case Description: We report the case of a 63-year-old hypertensive man who presented with the acute onset of confusion associated with a mixed expressive and receptive dysphasia. His medical history was significant for the recent institution of anticoagulation to manage atrial flutter. Digital subtraction angiography confirmed the presence of bilateral DAVMs. The vein of Labbe on both sides demonstrated only retrograde cortical venous filling from the malformations. Treatment included combined endovascular and microsurgical strategies. Conclusion: We describe an unusual case of bilateral dural AVMs involving the transverse sigmoid junction. Both lesions were associated with retrograde cortical venous drainage, and the larger left-sided lesion presented with hemorrhage necessitating surgical intervention. The origin of these lesions remains poorly understood, and this case may add to our understanding of this entity.