Synchronous chronic middle cerebral artery occlusion and ipsilateral dural arteriovenous fistula

Dural arteriovenous fistulas (dAVFs) are a complex family of vascular malformations. Most series discuss features in isolation of other vascular pathologies, despite evidence that dAVFs may arise in a setting of elevated angiogenic growth factors related to regional hypoxia. We describe a 72-year-old man with ischemic symptoms secondary to middle cerebral artery stenosis and an incidental ipsilateral Borden I dAVF. Balloon-occlusion single photon emission computed tomography demonstrated reversible ischemia within the basal ganglia consistent with fistula-related "steal" phenomenon. This case supports the hypothesis that dAVFs may arise secondary to angiogenic growth factors related to regional tissue hypoxia.