Intracranial Dural Arteriovenous Fistula as a Reversible Cause of Dementia: Case Series and Literature Review

Objective: Intracranial dural arteriovenous fistulas (DAVFs) can manifest with a reversible form of dementia and parkinsonism that may be related to medullary venous hypertension and impaired cortical venous drainage. We report a consecutive case series of patients with DAVFs who presented with cognitive decline and report angioarchitecture and outcomes of treatment. Methods: From a prospectively collected database of 389 cranial DAVFs, we identified patients who presented with progressive dementia. Data collected included demographic characteristics, other presenting symptoms, fistula location and type, preoperative and postoperative imaging findings, and treatment outcomes. Descriptive statistics were reported. Results: Of 389 patients with DAVF, 6 patients with progressive dementia (1.4%) were identified. All patients were male. Mean patient age was 68.6 years. Four patients had superior sagittal sinus DAVFs, 1 patient had a tentorial DAVF, and 1 patient had a transverse sinus DAVF. All patients had evidence of medullary venous hypertension on imaging with either reflux and arterialization of the transmedullary veins or venous congestion of the transmedullary veins. All patients underwent endovascular treatment and had reversal of dementia-related symptoms after a mean follow-up of 6.2 months. Conclusions: Cognitive decline is a rare but reversible manifestation of DAVFs that have impaired venous drainage of the transmedullary veins and associated medullary venous hypertension.