Baylor University Medical Center Proceedings April 2017 - 217

Previous reports on patients presenting with dementia
and parkinsonism showed frontal lobe, temporal lobe, and
basal ganglia ischemia. Ischemia was a direct result of the
connection between the DAVF and superior sagittal sinus.
It has been hypothesized that this leads to the development
of an arterial steal phenomenon believed to be responsible
for the ischemia. Local venous congestion was also involved
in the development of hypoxia. Dementia was attributed to
frontal lobe ischemia, while damage to the frontal white matter and basal ganglia was hypothesized to be the cause of the
parkinsonism (3, 10).
Other symptoms reported in our patient such as decreased
speech output may be the result of decreased frontal lobe perfusion. Seizures could be attributed to global venous congestion (8). Hemorrhage in the basal ganglia has been reported
to cause seizure-like tonic-clonic movements (5). It appears
that the seizures seen in our patient were more from venous
congestion than from hemorrhage. Reduced speech, as with
dementia, showed signiﬁcant improvement with postendovascular embolectomy.
Unlike most known causes of dementia syndromes, DAVFs
do not have a single constant or deﬁning symptom. The presentations of DAVFs are highly variable and may be reversible. DAVF represents one of the rare but reversible causes of
dementia. Early diagnosis and treatment may have the potential of dramatically improving patients' clinical condition and
minimizing long-term residual disability.

April 2017

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Dural arteriovenous fistula as a treatable dementia

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