Recurrent Stroke Like Episodes in a Young Woman with Multiple Dural Arteriovenous Fistulas

Background: Intracranial dural arteriovenous fistulas (dAVFs) may cause progressive headaches, neurological deficits, and serious complications related to abnormal venous drainage. Objectives: To describe the clinical progression, angiographic findings, treatment response, and complications in a young woman with multiple intracranial dAVFs. Methods: A descriptive case review integrated serial clinical assessments, computed tomography, digital subtraction angiography, magnetic resonance imaging, and endovascular treatment records. Results: A 23 year old woman presented with progressive pulsatile occipital headache, left sided weakness, and visual disturbances. Computed tomography revealed hyperdensity and surrounding edema. Angiography identified multiple dAVFs involving the left transverse and superior sagittal sinuses, supplied by bilateral middle meningeal and occipital arteries. Staged embolization temporarily improved symptoms and reduced shunt flow. Recurrent seizures required additional embolization. Three months after discharge, seizures and impaired consciousness recurred. Magnetic resonance imaging demonstrated superior sagittal sinus thrombosis and intraventricular hemorrhage. Further intervention was delayed, followed by neurological deterioration. Conclusions: Multiple intracranial dAVFs may demonstrate complex clinical progression despite initial treatment response. Sustained angiographic surveillance, timely reassessment, and multidisciplinary management are essential considerations for detecting persistent vascular abnormalities and potentially serious complications.