Treatment of Multiple Dural Arteriovenous Fistulas Associated with Visual Disturbances in a Chronic Schizophrenia Patient: A Case Report

Abstract

A 51-year-old woman presented with visual disturbances that had persisted for approximately one year. She had been taking psychiatric medication for schizophrenia. Brain magnetic resonance imaging showed engorged vessels in both hemispheres, and a delay in the mean transit time and time to peak was observed on perfusion images. The initial transfemoral cerebral angiography showed multiple dural arteriovenous fistulas (AVFs) with cortical venous reflux and venous ectasia. Both middle meningeal arteries (MMAs), superficial temporal arteries (STAs), and occipital arteries (OAs) were feeding the fistulas, and the superior sagittal sinus was the draining vein. Owing to the presence of multiple lesions and feeder arteries, a staged treatment was planned. We first performed the Onyx embolization of the left MMA, followed by the surgical ligation of the left STA, with subsequent embolization of the left OA. Finally, the venous ectasia was clipped. Importantly, after treatment, the patient’s schizophrenia-like symptoms improved. The patient could be originally misdiagnosed with schizophrenia. This case shows that staged and active treatment should be considered in case of multiple dural AVFs for improvement of symptoms. Key words: Arteriovenous fistula; Intracranial arteriovenous malformations; Schizophrenia