Reversal of diffusion restriction after embolization of dural arteriovenous fistula: Case report

BACKGROUND AND IMPORTANCE: We report a rare case of diffusion restriction caused by venous hypertension resulting from a dural arteriovenous fistula (DAVF) that completely reversed after successful embolization. CLINICAL PRESENTATION: A 54-year-old man presented with symptoms secondary to a DAVF. Magnetic resonance imaging (MRI) revealed left parieto-temporo-occipital diffusion restriction. The angiogram revealed a Cognard type III left lateral tentorial DAVF resulting in severe venous hypertension. Transarterial Onyx embolization was performed, resulting in angiographic cure of the fistula with normalization of the venous drainage in the left parieto-temporo-occipital region. A follow-up MRI examination performed 4 weeks after the embolization revealed resolution of the previously seen area of restricted diffusion. CONCLUSION: It is important to consider the possibility of diffusion restriction reversal, because misdiagnosis or the false assumption that irreversible cerebral infarction has occurred may inappropriately alter or delay the treatment of these aggressive lesions.