Dural arteriovenous fistula: a cause of hypoperfusion-induced intellectual impairment

A 76-year-old, right-handed man developed posttraumatic dural arteriovenous fistula (DAVF) involving the superior sagittal sinus. He developed slow but progressive intellectual deterioration and gait disturbance after a minimal head trauma. Cerebral angiography demonstrated a DAVF of the superior sagittal sinus with sinus thrombosis supplied by branches of the bilateral external carotid arteries, and a DAVF of the right sigmoid sinus supplied by the right occipital artery. Selective embolization was carried out. He showed marked improvement on neuropsychological testing, especially on test items which are supposed to tap functions of the right cerebral hemisphere which showed an improved cerebral blood flow. We concluded that the intellectual impairment of our patient was caused by cerebral hypoperfusion, especially of the right cerebral hemisphere.