Spontaneous Subdural Hematoma and Behavioral Changes Due to a Dural Arteriovenous Fistula. A Case Report and Literature Review

• Main Authors: Zenaida Milagros Hernández-Díaz, Juan Carlos Llíbre-Guerra, Marianela Arteche-Prior, Tania de la Paz-Bermúdez, Angel Francisco Águila-Ruiz, Luisa María Figueroa-García, María de los Ángeles Robinson-Agramonte
• Format: Article
• Language: English
• Published: MDPI AG 2019-06-01
• Series: Behavioral Sciences
• Subjects: behavioral changes; dural arteriovenous fistula; intracerebral hematoma; subdural hematoma; rare diseases
• Online Access: https://www.mdpi.com/2076-328X/9/6/63

Dural arteriovenous fistulas (DAVFs) represent 10−15% of intracranial arteriovenous malformations. Of these, only 12−29% cause intracranial hemorrhage. The presentation of DAVF as a subdural hematoma (SDH) and intraparenchymal hemorrhage (IPH) is infrequent; additionally, behavioral changes are not common among these patients. We report, for the first time in our country, the case of a 23-year-old man with no history of head injury, in which a brain computed tomography (CT) scan revealed SDH and IPH with behavioral disturbances. The angiotomography showed ecstatic venous vessels, indicating the presence of a DAVF, which was later confirmed by cerebral angiography. Endovascular therapy, which followed the clinical diagnosis, resulted in satisfactory evolution two years after treatment. A review of the literature concerning cases with DAVF and behavioral disturbances is presented. DAVF may lead to cognitive impairment, behavioral changes, and dementia as a result of diffuse white matter and thalamus modifications related to venous ischemia, and it should be considered as a reversible cause of vascular dementia.