Bithalamic infarction in a tentorial dural artero-venous fistula and thalamic dementia: a case report and systematic review

Purpose To report a case of bilateral thalamic infarction (BTI) presenting as progressive thalamic dementia due to a midline tentorial dAVF (TdAVF) and to provide a systematic review of the literature. Methods We performed a systematic literature review of previously reported cases of bi-thalamic signal changes due to dAVF considering population characteristics, clinical presentation, imaging findings, treatments, and outcomes. Results We found 29 papers from 1985 until 2021 describing 35 cases of BTI dAVF-related. We analysed 36 cases comprehensive of our case report. The mean age was 58.7 years (range 38–79), 91.6% were males ( n =33). Most cases presented with a subacute syndrome. In 86.1% ( n =31) of cases a TdAVF was found; 58.3% ( n =21) were type 2 Borden-Shucart fistulas, the remaining were mostly type 3. In 80.5% ( n =29), a thrombosed sinus was identified. 33.3% of cases ( n =12) had bi-thalamic haemorrhages. Endovascular treatment was performed in 83.3% of cases ( n =30). A total of 75% ( n =27) of cases had a good recovery. Conclusions BTIs due to dAVFs may present with subacute symptoms overlapping with several differential diagnoses. Prompt identification at MRI, before venous drainage failure and bleeding, is crucial for a good prognosis.