Introduction It is rare for dural arteriovenous fistula (DAVF) appearing only in parkinsonism and cognitive impairment. This is associated with venous reflux/congestion.

Aim of Study We report a case with DAVF, presented with gait disturbance and cognitive impairment as the first symptoms, disappeared completely after transvenous embolization.

Methods A 78-year-old female admitted with a 3-month-history of gait disturbance, memory impairment, and tinnitus. She showed bradykinesia, narrow shuffling gait, and poor short-term memory, suggested as Parkinson’s disease by outpatient doctor.

T2-weighted MR revealed flow void clusters and dilated cortical/medullary veins in supratentorial/infratentorial region. MRA showed multiple high signals adjacent to the left transverse and sigmoid sinus (TS, SS).

Cerebral angiogram demonstrated an extensive DAVF of left TS with multiple feeders. There was a right-left occipital arterial anastomosis, resulting in secondary fistular filling. Left SS was totally occluded with retrograde flow into superior sagittal sinus. There was a marked venous reflux into cerebral/cerebellar hemispheres.

Results We decided transvenous embolization of DAVF. The catheterization into left jugular-sigmoid-transverse sinus was failed due to complete obstruction of left SS. We approached to right internal jugular-sigmoid-transverse sinus and crossed torcula to left TS.

To prevent movement of coil by shunt flow, a basket by multiple detachable coils was formed as a wall at the bulbous portion of left TS. DAVF was completely occluded with TORNADO coils with normal flow direction of venous drainage. All symptoms were disappeared.

Conclusion Parkinsonism and cognitive dysfunction in DAVF is reversible when treated. Therefore, the prompt and exact diagnosis is important.

Disclosure of Interest Nothing to disclose