Objective: Our aim is to report a case of unusual manifestation of dural arteriovenous fistula (DAVF) which showed reversible asymmetric parkinsonism and vertical gaze limitation initially.

Background: Dural arteriovenous fistula (DAVF) is a rare type of cerebral arteriovenous malformation, which refers to an abnormal direct connection between an intracranial artery and a dural venous sinus. A DAVF initially presenting with parkinsonism is extremely rare, and vertical gaze limitation combined with asymmetric parkinsonism have not been described.

Methods: Single case report.

Results: A 58-year-old man referred to us due to bradykinesia and gait disturbance. His neurological examination revealed not only asymmetric parkinsonism, but also vertical gaze limitation. Routine laboratory tests and Mini Mental State Examination (MMSE) were normal. Brain magnetic resonance image (MRI) and cerebral artery angiography show high signal lesions in the right temporo-occipital area with obstructed right transverse and sigmoid sinus, and so he was diagnosed as DAVF. After successfully complete embolizations of the right transverse and sigmoid sinus DAVF with Onyx, parkinsonism and vertical gaze limitation symptoms fully recovered and dopamine transporter functional neuroimaging studies also improved markedly.

Conclusions: For now, we report for the first time a rare manifestation of DAVF presenting reversible asymmetric parkinsonism and vertical gaze limitation. As like this case, if there are abnormal parkinsonism and vertical gaze limitation, it should be considered diagnosis of DAVF as well as atypical parkinsonism including progressive supranuclear palsy (PSP).

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MDS Abstracts - https://www.mdsabstracts.org/abstract/reversible-asymmetric-parkinsonism-and-vertical-gaze-limitation-as-an-initial-manifestation-of-dural-arteriovenous-fistula/