A case of dural arteriovenous fistula associated with a putaminal hemorrhage

A 75-yearold man presented with convulsions and a history of minor head trauma. Fourteen days after the onset of trauma, he was comatose with a GCS of 7 and left hemiparesis. The NIH stroke scale score was 20, and the brain CT revealed a high density area, mainly in the right putamen. Thirty two days after the onset of trauma, subcortical hemorrhage appeared in the left temporal lobe. Cerebral angiography demonstrated a dural arteriovenous fistula (dAVF) draining into the left transverse-sigmoid sinus (TS). The retrograde venous drainage into the internal cerebral vein was observed. Retrospective review of the MRI obtained before the putaminal hemorrhage demonstrated that dAVF should be suspected when there is slight hyperintensity in the FLAIR image in deep brain structures and when visualization of the transverse sinus can be observed in patients with a history of minor trauma.