Case report

BMC Neurology

, 12:77

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

Unusual MRI findings of dural arteriovenous fistula: Isolated perfusion lesions mimicking TIA

  • Yong-Won KimAffiliated withDepartment of Neurology, Kyungpook National University HospitalCerebrovascular Center, Kyungpook National University Hospital
  • , Dong-Hun KangAffiliated withDepartment of Neuroradiology, Kyungpook National University HospitalCerebrovascular Center, Kyungpook National University HospitalSchool of Medicine Kyungpook National University
  • , Yang-Ha HwangAffiliated withDepartment of Neurology, Kyungpook National University HospitalCerebrovascular Center, Kyungpook National University HospitalSchool of Medicine Kyungpook National University Email author 
  • , Sung-Pa ParkAffiliated withDepartment of Neurology, Kyungpook National University HospitalSchool of Medicine Kyungpook National University

Abstract

Background

The diagnosis of transient ischemic attack (TIA) based on clinical history and objective findings, even including multiparametric MRI, can be misleading. We report two patients who presented with TIA-like deficits with isolated perfusion lesions in corresponding areas but were finally diagnosed as transient neurological symptoms associated with dural arteriovenous fistula (dAVF).

Case presentation

Two patients presented with transient focal neurological symptoms lasting less than one hour. An isolated perfusion deficit with no diffusion change in the clinically relevant area was shown on brain MRI, indicating transient ischemia as the most plausible cause of neurological symptoms. However, cerebral angiography let to diagnosis of dAVF in both cases. Intracerebral hemorrhage occurred after the initial diagnosis of TIA in one patient, and the small area of perfusion abnormality accompanied by the enlarged cortical vein in the other case helped to identify the dAVF through the further investigation. The pattern of perfusion-weighted imaging in both cases revealed increase of mean transit time and relative cerebral blood volume denoting the venous congestion in a clinically corresponding area.

Conclusion

Reported cases are uncommon clinical presentation of a dAVF, which can be misdiagnosed as TIA on clinical grounds. In rare cases, the isolated perfusion deficits could be attributable to venous congestion, despite the similar pattern of clinical presentation, such as with TIA.

Keywords

Transient ischemic attack Perfusion-weighted imaging Dural arteriovenous fistula Magnetic resonance imaging Transient ischemic attack mimics Intracerebral hemorrhage