| Summary: | Introduction Intracranial dural arteriovenous fistulae (dAVFs) are typified by pathological anastomoses between meningeal arteries and dural venous sinuses or cortical veins. DAVFs can mimic other neurologic disorders and produce a broad spectrum of signs and symptoms, including headache, tinnitus, vertigo, Parkinsonism, and visual field and gait disturbances. We present a case report of extensive dural AV Fistula which lead to brainstem ischemic stroke from compression of brainstem flow void. Methods Case Report Results 64 year old man with past medical History of Rheumatoid arthritis, presented with sudden onset of right facial weakness. On arrival patient was noted to be hypertensive to 200/105 and on exam noted to have right complete facial nerve palsy. Patient also revealed a significant history of severe, throbbing, posterior headaches in the last 1–2 months. Patient had CT head which was negative for bleed. CT angiography showed Abnormal hyperattenuating tubular vessel extending along the right cerebellar hemisphere and posterolateral pons extending towards the venous confluence at Galen. Over the course of 5 hours, the patient reported difficulty swallowing and intense headaches. MRI brain showed acute to early subacute infarct involving the right dorsolateral medulla and abnormal T2 prolongation involving essentially the entire cross‐section of the upper medulla and inferior pons representing edema. The patient was taken for Diagnostic catheter angiogram which showed dural AV fistula extending along the right cerebellar hemisphere. Onyx embolization was performed on the Right Middle meningeal artery and right Superior cerebellar artery with complete obliteration of dAVF. Conclusions The spectrum of signs and symptoms associated with DAVFs has been attributed to any one or combination of 6 pathophysiologic factors: the arteriovenous shunt, cerebral hypoxia and ischemia, increased venous pressure, retrograde drainage and secondary engorgement of basal sinuses, sinus obstruction, and subarachnoid hemorrhage secondary to involvement of the pial venous system. Prompt evaluation and management is necessary for patients presenting with neurological symptoms with headache.
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