Unusual clinical manifestations of dural arteriovenous malformations.

Fourteen patients had classical angiographic findings of intracranial dural arteriovenous malformations (AVM's). They presented with unusual central neurological signs and symptoms, including visual disturbances, hemiparesis, speech disturbances, gait ataxia, diffuse increased intracranial pressure, and intracranial hemorrhage. In 12 of the 14 patients there was a direct correlation between the clinical presentation and the venous drainage characteristics of the AVM's. The symptoms were probably related to a regional steal phenomenon in two patients. Six patients had direct surgical excision of the dural AVM. Five patients underwent endovascular embolization of the malformation and, in one case, the AVM was removed surgically after embolization. In one patient, the external carotid artery in the neck was ligated. Ten of the 14 patients had substantial clinical improvement or cure. A complete anatomical obliteration of the malformation was obtained in seven cases. None of the patients deteriorated clinically after therapy.