Reversible parkinsonism after treatment of dural arteriovenous fistula.

BACKGROUND AND PURPOSE

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.

CONCLUSION

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.