Paradoxical clinicoradiologic features of a cavernous dural arteriovenous malformation

A case of bilateral Barrow type D dural arteriovenous malformations (DAVMs) of the cavernous sinuses is described in a 66-year-old woman who, despite having moderate symptoms with partial resolution and benign findings on non-invasive imaging, was ultimately found to have associated leptomeningeal venous drainage on conventional angiography. This case illustrates the problem of discordance between clinical symptoms, non-invasive imaging and actual radiologic features predisposing to aggressive clinical behaviour in DAVMs detected by conventional angiography.