# A Case of Multiple Dural Arteriovenous Fistula-Like Findings Following Aneurysmal Subarachnoid Hemorrhage

## TL;DR

A woman developed multiple dAVF-like findings after treatment for a brain hemorrhage, suggesting new insights into how these fistulas form.

## Contribution

This is the first reported case of dAVF-like findings appearing within two weeks after endovascular treatment for subarachnoid hemorrhage.

## Key findings

- Multiple dAVF-like findings appeared two weeks after coil embolization for subarachnoid hemorrhage.
- Follow-up showed spontaneous resolution of these findings without intervention.
- The case suggests increased intracranial pressure may activate direct arteriovenous pathways.

## Abstract

Dural arteriovenous fistula (dAVF) is thought to arise from triggers like venous sinus thrombosis or trauma, though many aspects remain unclear. We report the case of a 48-year-old woman who developed multiple asymptomatic dAVF-like findings two weeks after coil embolization for subarachnoid hemorrhage (SAH). Initial angiography showed no dAVFs. Postoperative angiography showed cavernous sinus and middle meningeal artery dAVF-like findings without cortical venous reflux. Conservative management was chosen, and follow-up angiography at three months showed spontaneous resolution. The incidental emergence of multiple dAVF-like findings suggests that increased intracranial pressure due to SAH may have opened “direct physiological arteriovenous pathways”, contributing to the development of dAVF. To the best of our knowledge, no previous reports have described a case presenting dAVF-like findings within a short period (two weeks) following an uneventful endovascular treatment. This case provides important insights into the existence and activation of “direct physiological arteriovenous pathways” and may contribute to a better understanding of the pathophysiology and mechanisms underlying dAVF development in human.