Reversible Dementia With Bilateral White Matter Changes Caused by Dural Arteriovenous Fistula: Case Report and Review of the Literature.

Abstract

Dural arteriovenous fistula (DAVF) is a vascular malformation. Although rare, DAVFs can represent a potentially reversible cause of dementia. Bilateral white matter changes can be detected on the magnetic resonance imaging of patients with DAVFs. Familiarity with symptoms of DAVFs can reduce the incidence of misdiagnosis of dementia syndrome. This study aimed to explore the clinical manifestation, imaging characteristics, and prognosis of dementia with bilateral white matter changes caused by DAVFs. A 56-year-old man presented with memory deterioration, tinnitus, and weakness in both lower limbs for over 2 months. Magnetic resonance imaging of the brain revealed white matter signal changes in the bilateral ventricles and centrum semiovale, which manifested as low signal on T1-weighted imaging, high signal on T2-weighted imaging, fluid-attenuated inversion recovery, and diffusion-weighted imaging. Digital subtraction angiography revealed DAVFs along the lateral sinus. The patients' condition improved significantly after endovascular embolization of the DAVFs. DAVFs presenting with dementia are rare and cases with bilateral white matter alterations can be easily misdiagnosed as other diseases. If the patient has dementia and bilateral alterations in the white matter, a DAVF should be considered. This type of dementia is reversible and may be associated with venous hypertension caused by arteriovenous fistulas. Early digital subtraction angiography is important to reduce misdiagnoses.