Bilateral Cavernous Sinus Dural Arteriovenous Fistula Presenting With Subarachnoid Hemorrhage.

OBJECTIVE

To retrospectively analyze a case of bilateral cavernous sinus dural arteriovenous fistula (CSDAVF) presenting with subarachnoid hemorrhage (SAH), summarize its clinical features and treatment experience, and improve recognition of this condition.

CASE PRESENTATION: A 46-year-old man was admitted due to a sudden, severe headache lasting 3 hours. He had a history of recurrent headaches, conjunctival injection in both eyes, and blurred vision. Head CT showed SAH. Whole-brain digital subtraction angiography (DSA) revealed no intracranial aneurysm but suggested bilateral CSDAVF with cortical venous reflux. The patient underwent transvenous embolization via the inferior petrosal sinus using coils combined with Onyx-18. Postoperative angiography showed complete fistula occlusion and disappearance of abnormal venous drainage and cortical venous reflux. Symptoms improved significantly, and the patient recovered well at the 3-month follow-up.

CONCLUSION

Bilateral CSDAVF causing SAH is rare and often indicates a dangerous venous drainage pattern. In patients with SAH without an aneurysm but with ocular symptoms, CSDAVF should be considered. DSA is useful for diagnosis, and timely endovascular treatment can improve prognosis.