A 78-year-old woman presented with features of bilateral, asymmetric Parkinsonism for 1 year, with prominent difficulties with continence, swallowing and apathy. Brain imaging showed evidence of chronic venous sinus thrombosis with dilated serpiginous vessels over the brain surface in keeping with a dural arteriovenous fistula, together with high T2 signal on MRI in the basal ganglia. Having responded only modestly to levodopa, she received 6 months of anticoagulation followed by embolisation of the dural arteriovenous fistula, with good response. Cerebral dural arteriovenous fistula is a rare, structural cause of atypical Parkinsonism.
- Parkinson's disease
- clinical neurology
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Contributors LW conceived of the article, drafted and revised the article and liaised with the other authors. DM was one of the main clinicians involved in the patient’s care and contributed substantially to the drafting, revision and approval of the final version of the manuscripts, particularly imaging sections. NW was the main clinician managing this patient. She instigated the writing of the article, was substantially involved in producing the manuscript, critical review and approval of the final version.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Obtained.
Provenance and peer review Not commissioned; externally reviewed by Bastiaan Bloem, Nijmedgan, Netherlands.