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Parkinsonism caused by dural arteriovenous fistula (DAVF) is very rare, however, it is reversible by endovascular treatment. We herein report a case of parkinsonism caused by DAVF with review of previous literature.Case Presentation: An 87-year-old woman with parkinsonism and dementia was admitted to our hospital with disturbance of consciousness and aggravated parkinsonism symptoms. Plain CT revealed low-density areas in the brainstem and left cerebellar peduncle. Magnetic resonance images revealed hyperintense lesions on FLAIR, which had elevated apparent diffusion coefficient (ADC) values, in the same lesion of plain CT. However, no edematous change was detected. CT angiograms revealed obstruction of the left transverse and sigmoid sinuses. Dilations of the left superior petrosal sinus, left petrosal vein, and pontine veins were also noted. A low-density area on plain CT had a contrast effect. Cerebral angiography revealed a DAVF involving the left transverse sinus and fed by the left occipital and left middle meningeal arteries. Transarterial embolization (TAE) with Onyx obliterated the DAVF, and parkinsonism symptoms gradually improved. We reviewed 21 DAVF-derived parkinsonism cases, most of which were treated by TAE. Recent cases were treated with Onyx. In many cases, parkinsonism improved after endovascular treatment. Conclusion:DAVF-derived parkinsonism is rare but treatable by endovascular therapy. DAVF should be one of the differential diagnosis of the parkinsonisms.

Reports of middle meningeal arteriovenous fistula (MMAVF) are relatively rare, and reports of idiopathic MMAVF are extremely rare. In the past, diagnoses of MMAVF have been confirmed by cerebral angiography, but magnetic resonance angiography (MRA) resolution is improving. Here, we report two cases of idiopathic MMAVF that were diagnosed by unreconstructed time-of-flight MRA (MRA-TOF) and successfully treated by trans-arterial embolisation with endovascular treatment. Both patients suffered from pulsatile tinnitus, and MRI was performed. Two dilated vessels were revealed in the middle temporal fossa by unreconstructed MRA-TOF imaging. These dilated vessels were thought to be the middle meningeal artery and middle meningeal vein; therefore, we diagnosed both patients with MMAVF. Following angiography, both patients had coil embolisation with endovascular treatment, and their conditions improved. In cases of idiopathic MMAVF without a history of trauma, brain surgery, or endovascular surgery, unreconstructed MRA-TOF may be useful as a primary diagnostic tool, and endovascular treatment before bleeding may produce better outcomes.