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Case report
Tentorial dural arteriovenous fistula presenting as episodic weakness mimicking periodic paralysis
  1. Dilip Singh1,
  2. Arun Garg1,
  3. Aditya Gupta1,
  4. Gaurav Goel1,
  5. Rajiv Gupta2,
  6. Atmaram Bansal1
  1. 1Institute of Neurosciences, Medanta- the Medicity, Gurgaon, Haryana, India
  2. 2Department of Radiology, Medanta- the Medicity, Gurgaon, Haryana, India
  1. Correspondence to Dr Arun Garg, Institute of Neurosciences, Medanta- the Medicity, Gurgaon, Haryana 122001, India; arun.garg{at}


We report a rare case of episodic limb weakness caused by a tentorial dural arteriovenous fistula (DAVF) draining into the perimesencephalic veins. A middle-aged man presented with episodes of transient quadriparesis preceded by recurrent vomiting. The patient was initially suspected of having periodic paralysis but, due to the presence of recurrent vomiting and brisk reflexes, MR imaging of the brain was performed which revealed marked T2 hyperintensity of the brainstem and cervical cord along with multiple prominent flow voids. Cerebral angiography showed a Borden type 3 DAVF at the left tentorial margin which was draining into the perimesencepahlic and perimedullary veins and refluxing into the cervical epidural veins. The patient made a remarkable recovery after surgical interruption of the fistula.

  • MRI
  • Arteriovenous Malformation
  • Spinal cord
  • Vascular Malformation
  • Intervention

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  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sector.

  • Competing interests None.

  • Data sharing statement There are no additional unpublished data for our study

  • Provenance and peer review Not commissioned; externally peer reviewed.