Short communicationTwo cases of dural arteriovenous fistula presenting with parkinsonism and progressive cognitive dysfunction
Introduction
Dural arteriovenous fistula (DAVF) is a rare type of cerebral vasculopathy, which accounts for 10–15% of all intracranial arteriovenous malformations [1]. DAVFs are abnormal connections of the arterial and venous systems involving dural sinuses and branches of the external and internal carotid arteries, or vertebral arteries. Typically, DAVF exhibits various symptoms including pulsatile tinnitus, ophthalmoplegia, proptosis, headache, and cognitive dysfunction. DAVF with the onset of parkinsonian symptoms and cognitive dysfunction is rarely reported [2], [3], [4], [5], [6]. Here, two DAVF cases were reported presenting with parkinsonism and progressive cognitive dysfunction. These cases' diagnosis was eventually confirmed by 3D time-of-flight (TOF) magnetic resonance angiography (MRA) or digital subtraction arteriography (DSA). Although angiography is the gold standard for the diagnosis of DAVF, 3D TOF MRA as a noninvasive diagnostic tool we employed had provided a satisfactory delineation of DAVF. The causes of these two symptoms may be due to venous hypertension of deep cerebral vein and cortical venous congestion caused by DAVF, which eventually leads to basal ganglia and cortical dysfunction [3], [7].
Section snippets
Case 1
A 54-year-old man was admitted to our hospital with a 10-month history of slow-movement and slowed thinking. He was initially diagnosed as having Parkinson's disease by the outpatient doctor at the 7th month after the onset of the symptoms. Madopar, at the dose of 62.5 mg Qid was effective at the beginning. Later the symptoms gradually aggravated although madopar was added up to the maximum dose of 187.5 mg Qid. Slowness of movement, cognitive dysfunction and urinary incontinence finally made him
Discussion
DAVF is a rare cause for patients with parkinsonism. In 1999, Matsuda et al. described the first 3 cases of DAVF accompanied with parkinsonism and cognitive dysfunction [4]. Most of the reported DAVFs with parkinsonism and cognitive dysfunction were located in the transverse or sigmoid sinus with retrograde venous reflux into the straight sinus and/or cortical veins [2], [3], [4], [5], [6], [8]. The probable mechanism may be due to venous hypertension caused by DAVF which led to the dysfunction
Conflict of interest
The authors report no conflicts of interest.
Disclosures
None.
Author contributions
Study concept and design: Wei Luo. Acquisition of data: Yong Luo and Jun Qi. Drafting of the manuscript: Yong Luo and Jun Qi. Critical revision of the manuscript for important intellectual content: Zhidong Cen, Haitao Hu, Biao Jiang, and Wei Luo. Administrative and material support: Wei Luo.
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These authors contributed equally to this work and should be considered co-first authors.