Background Dural Arterio-venous fistulas (DAF) comprise 10%–15% of all intracranial vascular lesions. These are mostly acquired lesions. The DAF can be asymptomatic or they can present with nonaggressive symptoms (eg, tinnitus) or aggressive symptoms (eg, hemorrhage or neurological deficits).

Case report We are reporting a case with DAF, who presented with acute encephalopathy. The patient is a 62-year-old male who presented with 4 days history of headache and progressive confusion. About 2 months prior to this admission, the patient was diagnosed with DVT in lower extremity and also superior and lateral sinus thrombosis. He was fully anti-coagulated and his INR on this presentation was 2. MRI of head showed multiple engorged cerebral veins. Four vessels cerebral arteriogram showed DAF with several arterial feeders from middle meningeal arteries, occipital arteries and also bilateral vertebral arteries. Partial embolization of the fistula was achieved with ONYX immediately post procedure patient's mental status improved and on last follow-up patient came back to his baseline.

Conclusion DAF can present with acute encephalopathy due to venous hypertension.

Competing interests None.