A 54-year-old man developed apathy and memory impairment in 3 months. MRI showed bilateral thalamic hyperintensities with dilated cortical veins in the right cerebellum. Angiography revealed dural arteriovenous fistula (dAVF) at right transverse-sigmoid sinuses with retrograde flow through the vein of Galen (figure 1). Transvenous coil embolization improved his MRI findings (figure 2) and Wechsler Memory Scale–Revised scores from 55 at baseline to 105 in the delayed recall index.
Brain MRI on T2-weighted (A, C) and diffusion-weighted (B) images. Right external carotid angiogram shows feeding arteries from the occipital artery to the transverse-sigmoid sinuses (D, arrow) with filling into the vein of Galen (E, arrow). Right internal carotid angiogram shows the superior sagittal sinus draining into only the left transverse sinus (F).
Brain MRI on T2-weighted (A, C) and diffusion-weighted (B) images.
dAVF is a rare cause of bithalamic lesions1 and cognitive impairment. His bithalamic venous congestion was caused by unilateral transverse-sigmoid dAVF due to noncommunication between the right and left transverse sinuses as anatomical variation.2
AUTHOR CONTRIBUTIONS
E. Iwasawa: drafting/revising the manuscript, study concept or design, acquisition of data, analysis or interpretation of data. S. Ishibashi: drafting/revising the manuscript, study concept or design, analysis or interpretation of data, study supervision. K. Miki and Y. Yoshino: treating physicians of the patient, study concept or design. S. Nemoto: treating physician of the patient, study supervision. H. Mizusawa: study supervision.
STUDY FUNDING
No targeted funding reported.
DISCLOSURE
The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
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- © 2013 American Academy of Neurology
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