Clinical characteristics, imaging, treatment, and prognosis of dural arteriovenous fistula presented with Parkinsonism- a systematic review.

Abstract

Dural arteriovenous fistulas (DAVFs) are abnormal arteriovenous shunts that occur between intracranial arteries and venous sinuses, meningeal veins, or cortical veins. These lesions can lead to pathological changes such as cerebral edema, increased intracranial pressure, metabolic dysfunction in the brain, venous sinus thrombosis, and vascular rupture with hemorrhage. Clinically, DAVFs rarely present as Parkinsonism, often coexisting with dementia. While there are numerous global reports of DAVF with cognitive impairment as the primary symptom, cases of DAVF presenting predominantly with Parkinsonism are exceedingly rare. Secondary Parkinsonism in DAVF may be associated with deep venous reflux and venous hypertension involving the basal ganglia. Severe dementia symptoms may overshadow Parkinsonian features, complicating the clinical diagnosis of DAVF-induced Parkinsonism. This article aims to review published case reports and series to summarize the clinical and imaging characteristics (CT, MRI, and angiography) of these patients, evaluate the quality of the cases, and hypothesize potential pathophysiological mechanisms, providing clinical guidance for the management of DAVF-associated Parkinsonism.