Seizure as the first symptom of cavernous sinus dural arteriovenous fistula: A case report and literature review

Cavernous sinus dural arteriovenous fistula (CS-DAVF) is an abnormal arteriovenous communication associated with a variety of clinical manifestations. The previous literature has rarely reported the occurrence of CS-DAVF with seizures and cerebral hemorrhage, signaling the need for more case reports and literature review in this area. A 62-year-old Chinese female presented with a paroxysmal loss of consciousness, accompanied with involuntary eye movement to the left, chewing issues, salivation at the right corner of the mouth, and bit tongue. The brain computed tomography revealed that the left temporal lobe was hemorrhagic. Brain scan and contrast-enhanced magnetic resonance imaging showed diffuse meningeal enhancement and lesions in the left frontoparietal temporal lobe, insular lobe, and hippocampal head region. Electroencephalography demonstrated continuous emission of spike and slow waves in the left hemisphere. With the aid of digital subtraction angiography, the patient was confirmed with a diagnosis of CS-DAVF draining into the ipsilateral cavernous sinus, intercavernous sinus, contralateral cavernous sinus, left superior ophthalmic vein, left lateral fissure vein, and left pterygoid venous plexus. The fistula was closed with interventional embolization through the femoral vein, and immediate angiography showed complete resolution of CS-DAVF after operation. The patient did not manifest any post-operative complications. This case highlights that the prevention of epilepsy, cerebral hemorrhage, and other serious complications is extremely important for good prognosis, especially in some patients presenting with serious clinical symptoms. It also sheds light on the necessity to consider the diagnosis of CS-DAVF if seizures, although extremely rare, are present.