Stroke-Mimic: An Intracranial Dural Arteriovenous Fistula Revealed by New-Onset Seizures and Post-Ictal Deficit

Intracranial dural arteriovenous fistulas (iDAVFs) are rare vascular malformations with diverse neurological symptoms depending on their venous drainage pattern. We describe a 59-year-old man who presented with transient right-sided weakness and facial droop following new-onset seizures. CT demonstrated asymmetric arterial-phase enhancement of the left transverse sinus and cortical veins, while MRI revealed left occipitotemporal and cerebellar hemorrhages consistent with venous congestion. Digital subtraction angiography confirmed a high-grade left anterior condylar iDAVF with cortical venous reflux (Borden II; Cognard IIa+b). Endovascular embolization was unsuccessful because of challenging vascular anatomy. Definitive management was achieved through surgical disconnection and targeted sinus coiling. This case highlights the diverse presentations of iDAVFs and emphasizes the importance of considering a vascular etiology in patients with atypical stroke-like or postictal deficits.