title: A thrombophilic patient with a dural arteriovenous fistula presenting sensory aphasia and complicated with an acute pulmonary embolism.
abstract: 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.
authors.affiliation: Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Chung-Hsing
authors.initials: CH
authors.lastname: Chou
authors.forename: Jiann-Chyun
authors.initials: JC
authors.lastname: Lin
authors.forename: Chun-Jen
authors.initials: CJ
authors.lastname: Hsueh
authors.forename: Giia-Sheun
authors.initials: GS
authors.lastname: Peng
mesh_terms: 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*