Dural arteriovenous fistulae after cerebral infarction: report of two cases.

Abstract

We first report 2 patients in whom dural arteriovenous fistulae (dAVFs) developed after cerebral infarction. One patient was a 49-year-old man who had a right embolic stroke 6 months after his first ischemic attack. Angiograms showed a de novo left transverse sigmoid sinus dAVF. One year later, shunt flow through the dAVF was increased. The second patient was a 45-year-old woman who presented with right cerebral infarction and moyamoya disease. Three weeks later, she underwent right superficial temporal artery-middle cerebral artery bypass. Ten months after the operation, angiograms showed the development of dAVFs in the left transverse sigmoid sinus and progressive moyamoya disease. We document the first patients with cerebral infarction and progressive moyamoya disease in whom a de novo dAVF developed. Moyamoya disease and dAVF are associated with an increase in dural angiogenic factors, and ischemia induces their increase. This may be the mechanism by which vaso-occlusive ischemia contributes to the formation of de novo dAVFs.