Intracranial dural arteriovenous fistulae (DAVF) within the deep cerebral vasculature are diagnostically challenging because of their variable clinical presentation and typical bilateral neuroimaging findings mimicking inflammatory, infectious, and metabolic processes. Increasingly, reports have emerged highlighting the diagnostic and treatment challenges of these lesions and their associated high morbidity and rapid clinical deterioration when untreated. We describe here a case series of 4 patients with deep cerebral DAVF who presented with impaired arousal or memory and behavioral changes. In all patients, the initial differential diagnosis included metabolic, inflammatory, infectious, or neoplastic disease, with an eventual correct diagnosis obtained after catheter angiography had demonstrated arterialization of the deep venous structures, including the vein of Galen. All patients were successfully treated with endovascular embolization, with 1 patient requiring additional surgical treatment. We review the contemporary diagnostic evaluation and management of DAVF within the deep cerebral vasculature. With rapid diagnosis and treatment, a favorable outcome is possible.

中文翻译：

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深度双侧影像学改变的进行性神经学衰退：硬脑膜动静脉瘘的蛋白质表现。

深部脑血管系统中的颅内硬脑膜动静脉瘘（DAVF）具有临床挑战性，因为它们的临床表现各异，并且典型的双侧神经影像学发现模仿了炎症，感染和代谢过程。越来越多的报道凸显了这些病变的诊断和治疗挑战以及它们的高发病率和未经治疗的快速临床恶化。我们在这里描述了4例患有深部脑DAVF的患者，这些患者表现出唤醒或记忆力受损以及行为改变。在所有患者中，最初的鉴别诊断包括代谢性疾病，炎性疾病，感染性疾病或赘生性疾病，经导管血管造影证实深静脉结构动脉化后，最终获得正确诊断。包括盖伦的脉络。所有患者均成功接受血管内栓塞治疗，其中1例患者需要接受其他外科手术治疗。我们审查了当代诊断评估和深部脑血管内DAVF的管理。通过快速的诊断和治疗，可能会有良好的结果。