Cerebral sinus venous thrombosis (CSVT) is a rare cause of intracranial hypertension and headache. Approximately ⅓ of patients with dAVF also present with CSVT. CSVT can lead to dAVF due to persistent venous hypertension and sinus occlusion. Conversely, dAVF can lead to CSVT due to turbulent flow causing prothrombotic state.

A single-patient case report was conducted.

A 41 year old female with a past medical history of migraines and hypertension presented to the hospital after she was examined outpatient for headache and blurred vision and found to have papilledema. A lumbar puncture was performed in the emergency department with opening pressure of 51 cm H20. The patient was admitted for further workup. MRI venogram revealed nonvisualization of the right transverse sinus and right internal jugular vein. Given clinical symptoms and imaging, high concern for CSVT. Patient started on heparin drip. DSA was performed demonstrating superior sagittal occlusion, transverse sinus thrombosis, and internal jugular thrombosis with significant venous drainage in the right MMA, occipital artery branches. Repeat DSA several days later performed for embolization of the right MMA and right occipital artery. After embolization, there was evidence of persistent flow on dAVF from the right vertebral artery. Post-procedure, the patient was transitioned to apixaban and developed transient occipital pain attributed to post-embolization inflammation, which resolved following an occipital nerve block and short prednisone course. 

This case underscores the importance of considering a dural AVF in patients with CVST of atypical distribution or unexplained elevated ICP. Angiographic evaluation allows for definitive diagnosis, and early endovascular intervention can prevent recurrent thrombosis and other complications.