Dural arteriovenous fistula: CT appearance case report and review

Images of dural arteriovenous fistula (DAVF) on computed tomography (CT) are usually normal when no hemorrhages have occurred from the DAVF. Therefore, it is difficult to diagnose DAVF by plain CT scans which are usually performed in an initial examination. We present a rare case with DAVF in the transverse-sigmoid sinus that could be diagnosed by reversible speckled high-density spots on a plain CT scan. A 46-year-old man had suffered from depression and had taken some antidepressants for 4 years. He developed a Gerstmann's syndrome and came to our hospital. On a plain CT scan obtained on admission, multiple high-density spots were demonstrated scattered in the left temporal, parietal, and occipital lobes. Subsequently, a digital subtraction angiography was performed. A DAVF in the left transverse-sigmoid sinus was apparent on the angiogram. The DAVF was successfully treated with endovascular surgery. The speckled high density decreased on the postoperative plain CT scan. Multiple high-density abnormalities in the brain shown on a plain CT scan are a rare but important finding for diagnosis of DAVF. Further examinations such as magnetic resonance angiography or digital subtraction angiography should be performed in case with these changes to access the possibility of DAVF.