Intracranial Dural Arteriovenous Fistula Presenting With Bulbar and Myelopathic Features: Case Report and Literature Review

Intracranial dural arteriovenous fistulas are defined as pathological anastomoses between meningeal arteries and dural venous sinuses or cortical veins. Rarely, they could drain into the venous system in and around the craniocervical junction and cause myelopathy and/or bulbar features. Due to the clinical and radiological features, prompt diagnosis poses a challenge, as there are several neurological differential diagnoses. Several mechanisms for the presentation have been considered, such as venous hypertension, direct compression by enlarged veins, and ischaemia due to infarcts or due to arterial steal. Digital subtraction angiography (DSA) is the gold-standard diagnosis for dural arteriovenous fistulas, where the visualisation of feeding arteries and the characterisation of venous drainage allows diagnosis and grading. Treatment options include conservative management, invasive (microsurgery) or minimally invasive options (transarterial or transvenous embolisation). We present a 32-year-old male who presented with myelopathy and bulbar features. Angiography demonstrated an intracranial dural arteriovenous fistula, which was successfully treated surgically.