title: High-grade dural arteriovenous fistula simulating a bilateral thalamic neoplasm.
abstract: Dural arteriovenous fistulae (dAVF) provide a diagnostic challenge and must be part of a broad differential in pursuit of a difficult diagnosis or unusual presentation. This case report demonstrates an initially misguided diagnosis of bilateral thalamic neoplasm and demonstrates the importance of continued pursuit until the correct diagnosis is obtained. Moreover, to our knowledge, this is the first reported case of a dAVF simulating a bilateral thalamic neoplasm. We present a patient with a provisional diagnosis of bilateral thalamic neoplasm based on clinical history and an advanced imaging workup including MR spectroscopy. Subsequent biopsy suggested venous congestion, hypoxia, and edema without neoplasia. Routine post-operative CT the following day revealed suggestion of dAVF due to the presence of residual contrast from prior unrelated abdominal CT. Cerebral angiography eventually revealed a Cognard grade IIb dAVF. Trans-arterial Onyx embolization resulted in a dramatic clinical and radiographic improvement. This case highlights an unusual presentation and challenging diagnosis of a dAVF and the importance of pursuing the correct diagnosis.
authors.affiliation: Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States. p-sugrue@northwestern.edu
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Sugrue
authors.forename: Michael C
authors.initials: MC
authors.lastname: Hurley
authors.forename: Bernard R
authors.initials: BR
authors.lastname: Bendok
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Surdell
authors.forename: Numa
authors.initials: N
authors.lastname: Gottardi-Littell
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Futterer
authors.forename: Kenji
authors.initials: K
authors.lastname: Muro
authors.forename: H Hunt
authors.initials: HH
authors.lastname: Batjer
mesh_terms: D001706:Biopsy; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000473:pathology; D002533:Cerebral Angiography; D003072:Cognition Disorders / Q000209:etiology; D003937:Diagnosis, Differential; D004621:Embolization, Therapeutic; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008569:Memory Disorders / Q000209:etiology; D008875:Middle Aged; D013238:Stereotaxic Techniques; D013786:Thalamic Diseases / Q000175:diagnosis* / Q000473:pathology; D013788:Thalamus / Q000473:pathology; D014057:Tomography, X-Ray Computed