Objective:

NA

Background:

Confabulation is a neuropsychiatric symptom characterized by creation of false memories without deceptive intent. While commonly associated with Wernicke-Korsakoff spectrum disorders, confabulation can occur with bilateral thalamic pathology. Here, we present a case of dural arteriovenous (AV) fistula causing acute bilateral thalamic edema, manifesting as confabulation.

Design/Methods:

A 65 year-old male with diabetes presented after being found down in his apartment. The prior day, the patient was observed in good health while working as a security guard. Exam on presentation was notable for paucity of spontaneous speech, disorientation to location and year, and confabulation. When asked about his occupation, the patient stated he directed a string quartet. His brother and nephew were at bedside, whom he confidently identified as his cousins. A CT scan of the chest found pulmonary emboli and a brain CT showed a dorsal parafalcine subdural hemorrhage. MRI revealed bilateral thalamic FLAIR hyperintensities. Digital subtraction angiography revealed a high grade vein of Galen dural AV fistula supplied by the middle meningeal, occipital, and posterior meningeal arteries resulting in venous congestion of the thalami, cerebellum, and brainstem. The patient underwent venous coiling and had full resolution of symptoms. On follow-up MRI, the thalamic hyperintensities remained present, yet improved.

Results:

NA

Conclusions:

Galenic venous congestion arising from dural AV fistula and resultant thalamic encephalopathy is a well-documented, albeit rare, phenomenon. While the presentation is usually more indolent, here, we present an episode of acute-onset encephalopathy with confabulation resulting from thalamic venous congestion. This pathology should be considered in the diagnostic approach to undifferentiated confabulation.