A thrombophilic patient with a dural arteriovenous fistula presenting sensory aphasia and complicated with an acute pulmonary embolism.
BACKGROUND
Neuropsychiatric symptoms as the initial presentation of dural arteriovenous fistula (DAVF) are unusual. Anticoagulation therapy may be warranted for prevention of further thromboembolism if an underlying thrombophilia condition is diagnosed.


METHODS
We present a 70-year-old woman with sensory aphasia, who was diagnosed with a DAVF, Cognard type II a + b, by cerebral angiography. Her stroke-like syndrome resolved after transarterial embolization of the left occipital and middle meningeal arteries. Meanwhile, hypercoagulability was found because of hyperhomocysteinemia and the presence of a lupus anticoagulant. One month later, she suffered an acute pulmonary embolism and was started on anticoagulation therapy before stereotactic radiosurgery.


CONCLUSIONS
Sensory aphasia may be the initial manifestation of a transverse-sigmoid sinus DAVF even if there are no symptoms such as headache or tinnitus. We postulate that early anticoagulation therapy is indicated for preventing thromboembolism in DAVF patients with thrombophilia because the possibility of intracranial bleeding has been reduced by embolization.
Chou
Chung-Hsing
CH
Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Lin
Jiann-Chyun
JC
Hsueh
Chun-Jen
CJ
Peng
Giia-Sheun
GS
D000368:Aged; D001041:Aphasia, Wernicke / Q000209:etiology*; D020785:Central Nervous System Vascular Malformations / Q000150:complications*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods; D008279:Magnetic Resonance Imaging; D011655:Pulmonary Embolism / Q000150:complications*; D019851:Thrombophilia / Q000150:complications*