Reversible parkinsonism after treatment of dural arteriovenous fistula.
OBJECTIVE
The most common causes of parkinsonism are degenerative and irreversible. Structural causes of reversible parkinsonism are exceptionally rare, but have been reported in association with deep cerebral venous thrombosis and dural arteriovenous fistula (DAVF). We now report a case of parkinsonian syndrome reversed by treatment of a dural arteriovenous malformation.


METHODS
Case report with retrospective review of relevant clinical, imaging, and treatment data.


RESULTS
A 79-year-old man presented with complaints of a slowly progressive parkinsonian syndrome and tinnitus. Brain magnetic resonance imaging (MRI) showed numerous serpiginous flow voids highly suggestive of a vascular malformation. Cerebral angiography revealed a Cognard grade IIa + b left transverse sinus DAVF. The patient underwent combined endovascular and surgical treatment in three stages over a week's time, with total obliteration of the DAVF and complete normalization of his symptoms and neurological examination.


CONCLUSIONS
Although rare, DAVF should always be considered as a potential cause of progressive parkinsonism. This diagnosis is of great importance because of its potential reversibility.
Nogueira
Raul G
RG
Neurocritical Care and Vascular Neurology Section, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. rnogueira@partners.org
Baccin
Carlos E
CE
Rabinov
James D
JD
Pryor
Johnny C
JC
Buonanno
Ferdinando S
FS
Hirsch
Joshua A
JA
D000368:Aged; D015901:Angiography, Digital Subtraction; D001921:Brain / Q000098:blood supply / Q000473:pathology; D020785:Central Nervous System Vascular Malformations / Q000150:complications* / Q000473:pathology / Q000628:therapy*; D002533:Cerebral Angiography; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D020734:Parkinsonian Disorders / Q000209:etiology* / Q000473:pathology; D014012:Tinnitus / Q000209:etiology / Q000473:pathology; D016896:Treatment Outcome