Safety of Thrombolysis in a Patient with an Intracranial Dural Arteriovenous Fistula.

Intracranial dural arteriovenous fistula is an abnormal connection between an artery and a vein that has an increased risk of bleeding. This case report presents a 53-year-old man diagnosed with a dural arteriovenous malformation fistula in occipital topography, lacking therapeutic indication because of an extension. He was admitted to an intensive care unit due to a high-risk pulmonary thromboembolism with indication for thrombolysis. Taking into account the hemorrhagic risk associated with arteriovenous malformation, the authors discuss the therapeutic options and the inherent risks. LEARNING POINTS: Intracranial dural arteriovenous fistulas are pathologic shunts between dural arteries and veins that have an inherent risk of intracranial hemorrhage.Systemic thrombolytic agents are a therapeutic option for high-risk pulmonary thromboembolism. Their potential benefits outweigh the risk of life-threatening bleeding; however, careful patient risk stratification should be performed and other options, such as surgical embolectomy or percutaneous catheter-directed treatment, should be considered if available.Multidisciplinarity is the key to better therapeutic decisions and the patient's opinion should always be taken into account.