Significance of Gradient-Echo Magnetic Resonance Imaging in Dural Arteriovenous Fistula Mimicking Hyperacute Ischemic Stroke

초록

Dural arteriovenous fistulas (DAVFs) could plausibly increase the risk of intracranial hemorrhage after intravenous (IV) recombinant tissue plasminogen activator (r-tPA) administration in acute stroke, although the actual bleeding risk associated with DAVFs after IV thrombolysis is not yet known. When DAVFs manifest symptoms of stroke, especially within 4.5 hours of onset, diagnostic ambiguity on non-contrast computed tomography makes it difficult to decide whether IV r-tPA treatment should be administered. Waiting for advanced neuroimaging to be performed is not sufficiently time-efficient for the diagnosis of DAVFs in the time window of thrombolysis. Here, we report a case of DAVF mimicking hyperacute stroke where IV r-tPA administration was halted following additional gradient-echo magnetic resonance imaging in a situation that required rapid decision regarding administration of a thrombolytic agent.

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