Computed tomographic and digital subtraction angiography evaluation of ophthalmic-ethmoidal artery dural arteriovenous fistula

Ophthalmic-ethmoidal dural arteriovenous fistula (DAVFs) is a rare type of dural arteriovenous fistulas and usually presenting with spontaneous subarachnoid hemorrhage, subdural hemorrhage or ocular symptoms. We present a case of a 59-year old gentleman presenting with acute headache, vomiting and generalized weakness. CT study of the brain revealed a large left frontal hematoma and abnormal aneurysmal sac with dilated cortical vein, communicating with the superior sagittal sinus. Conventional angiography confirmed diagnosis of ruptured ophthalmic-ethmoidal DAVF, resulting in a frontal intra-axial hemorrhage. Anterior fossa DAVFs are extremely rare, difficult to diagnose and treat. CT angiography is initial method of diagnosis, but digital substruction angiography remains the gold standard of confirming dural fistulas.