Case of the Season: Dural Arteriovenous Fistula Mimicking a Bithalamic Neoplasm or Viral Encephalitis

Reversible thalamic dementia caused by venous hypertension of bilateral thalami resulting from multiple intracranial dural arteriovenous fistulas successfully obliterated by endovascular treatment using liquid embolic materials: A case report and literature review

“…Hemorrhagic transformation, including intracerebral hematoma, microhemorrhage, or petechial hemorrhage, within the thalami, basal ganglia, or deep brain structures, may represent that the lesion was left untreated for a long time or from chronic venous congestion. [14,19,25,27,29] In our case, small hematoma at the right medial occipital lobe may result from venous congestion of the internal occipital vein receiving drainage from the basal vein of Rosenthal. Further, there were petechial hemorrhages at bilateral thalami and basal ganglia.…”

“…The presence of the occluded or thrombosed straight sinus may cause the formation of the tentorial DAVF, indicative of this acquired lesion. [25,27,29] Most patients harboring tentorial DAVFs including our case had angiographic occlusion of the straight sinus. [8,[14][15][16]18,21,22,24,25,27,29,30,32] Interestingly, Iwasawa et al [28] reported a patient with DAVF at transverse-sigmoid sinus without thrombosed straight sinus and speculated that an anatomical variation, i.e., noncommunication between the right and left transverse sinuses, may play a major role in producing thalamic dementia by increasing drainage into the deep venous structure.…”

“…[25,27,29] Most patients harboring tentorial DAVFs including our case had angiographic occlusion of the straight sinus. [8,[14][15][16]18,21,22,24,25,27,29,30,32] Interestingly, Iwasawa et al [28] reported a patient with DAVF at transverse-sigmoid sinus without thrombosed straight sinus and speculated that an anatomical variation, i.e., noncommunication between the right and left transverse sinuses, may play a major role in producing thalamic dementia by increasing drainage into the deep venous structure. Tanaka et al [17] reported a patient with tentorial DAVF associated with occlusion of bilateral transverse sinuses compromising hemodynamics into bilateral thalami.…”

“…[13,14] We reviewed the literature of patients with thalamic dementia caused by venous hypertension of bilateral thalami from cranial DAVFs and found 28 cases, including our present case, with 30 fistulas due to bilateral lesions in two cases [Table 1]. [8,10,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] The collected data in this review included demographic data (i.e., gender and age of patient), location and arterial supply of the fistulas, symptoms and signs of the patients, angiographic occlusion of the straight sinus, presence of intracerebral hemorrhage, treatment of the fistulas, and neurological outcome after treatment. From the literature review, there were 25 men (89.3%) and 3 women (10.7%) with median age of 59.5 years, ranging from 43 to 77 years.…”

Progressive Neurological Decline with Deep Bilateral Imaging Changes: A Protean Presentation of Dural Arteriovenous Fistulae

“…Increasingly, deep cerebral DAVF are being recognized as a cause of these presentations and imaging findings. Case reports have emerged over the prior decade showing that this type of presentation has led to misdiagnoses that include Creutzfeldt-Jakob disease [1], progressive dementia [2,3], parkinsonism [4], brainstem glioma [5][6][7], and viral encephalitis [6].…”