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Updated: Apr 15, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Rapidly progressive dementia caused by a superior sagittal sinus dural arteriovenous fistula: a case report
Ryoko Imazeki1, Kazumitsu Amari, Tomoko Sekiguchi
1Department of Neurology, Yokohama Brain and Spine Center, 1-2-1 Takigashira, Isogo-ku, Yokohama 235-0012, Japan. Kisaragi1967@aol.com.
Abstract:
We describe the case of a 72-year-old man who presented with dementia that had progressed rapidly over a few months. Laboratory analysis of blood and cerebrospinal fluid (CSF) showed no abnormalities, with the exception of a slightly increased CSF protein level. Results of routine magnetic resonance imaging (MRI) including diffusion-weighted imaging (DWI) and magnetic resonance angiography (MRA) were unremarkable. However, detailed neuroimaging studies including contrast-enhanced T1-weighted MRI and conventional angiography revealed a superior sagittal sinus (SSS) dural arteriovenous fistula (DAVF). After endovascular embolization and surgical interruption of all arteries feeding the DAVF, the dementia reversed. We should be aware of the possibility of DAVF as the cause of rapidly progressive dementia even if routine MRI reveals no or only minimal abnormality.
Insights
A superior sagittal sinus dural arteriovenous fistula (DAVF) can cause rapidly progressive dementia. Prompt diagnosis and treatment of DAVF can reverse dementia symptoms, even with initially unremarkable MRI scans.
Area of Science:
- Neurology
- Radiology
- Neurosurgery
Background:
- Rapidly progressive dementia (RPD) presents a diagnostic challenge, often necessitating advanced neuroimaging.
- Dural arteriovenous fistulas (DAVFs) are abnormal connections between dura mater arteries and venous sinuses, rarely presenting as RPD.
Observation:
- A 72-year-old man exhibited rapidly progressing dementia with normal routine blood and cerebrospinal fluid (CSF) analysis, apart from slightly elevated CSF protein.
- Standard magnetic resonance imaging (MRI), including diffusion-weighted imaging (DWI) and magnetic resonance angiography (MRA), showed no abnormalities.
Findings:
- Detailed neuroimaging, specifically contrast-enhanced T1-weighted MRI and conventional angiography, identified a superior sagittal sinus dural arteriovenous fistula (SSS-DAVF).
- Following endovascular embolization and surgical management to ligate feeding arteries, the patient's dementia fully reversed.
Implications:
- This case highlights the importance of considering SSS-DAVF in the differential diagnosis of RPD, even with non-specific initial findings.
- Advanced neuroimaging and interventional techniques are crucial for diagnosing and treating DAVF-induced dementia, offering potential for complete recovery.
