Thoracic dural arteriovenous fistula presenting with isolated pseudobulbar palsy mimicking brainstem lesion: A case report.

Spinal dural arteriovenous fistulas (DAVF) are usually associated with neurological dysfunction adjacent to the shunt point; however, the symptoms are uncommon far from the site of fistula. To our knowledge, this is the first report of a patient with rapidly progressive isolated pseudobulbar palsy due to thoracic DAVF.We report a patient with thoracic DAVF presenting with remote symptoms of brainstem congestion. The patient was a 36-year-old man who presented with a sudden history of vomiting, dysphagia, and flaccid weakness in the four limbs. Intracranial magnetic resonance (MR) imaging at a local hospital demonstrated T2 signal hyper-intensity within the medulla, and he was referred to our hospital for a suspected brainstem lesion. However, cervical MR imaging revealed a dilated and tortuous perimedullary venous plexus, and spinal angiography revealed DAVF in T5/6 with a feeding artery from the intercostal artery. Following obliteration of the fistula, the progression of the disease was stopped and the symptoms improved.Although rare, thoracic DAVF may present symptoms resembling brainstem infarction. Prompt surgical intervention is necessary for patients with thoracic DAVF presenting with rapidly progressive pseudobulbar palsy.