Dural carotid-cavernous fistula presenting with confusion and expressive aphasia

We report a patient who presented with confusion and expressive aphasia at the onset of a cortical venous reflux (CVR) related to a known dural carotid-cavernous fistula (DCCF). CVR and venous congestion are rare findings in a DCCF, however, it is important to recognize these findings early to reduce the associated risks of venous hemorrhage and infarction. To our knowledge, no previous report has described an association of expressive aphasia with CVR from a DCCF. This patient highlights the potential for venous congestion secondary to CVR from a DCCF presenting with a constellation of symptoms, including confusion and expressive aphasia with corresponding MRI findings. Clinicians should consider a DCCF in the differential diagnosis of this clinical presentation, with corroborative imaging findings.