Recurrent Dural Arteriovenous Fistula following Cerebral Venous Sinus Thrombosis Related to COVID-19 Vaccination: A Case Report.

Cerebral venous sinus thrombosis (CVST) is rare but serious adverse complication of coronavirus disease 2019 (COVID-19) vaccination. CVST can sometimes lead to development of dural arteriovenous fistula (DAVF), but DAVF secondary to CVST following COVID-19 vaccination is rarely reported. Here, we present a case of CVST occurring after COVID-19 vaccination, followed by subsequent development of DAVF, which was successfully treated. A 45-year-old male presented with headache and progressive visual impairment beginning 4 days after COVID-19 vaccination. Papilledema was noted. Cerebrospinal fluid pressure was elevated at 300 mmH2O, and magnetic resonance imaging (MRI) revealed right transverse sinus thrombosis, prompting initiation of anticoagulant therapy. Four months later, MRI suggested DAVF in right transverse sinus, and he was referred to our department. Digital subtraction angiography confirmed DAVF in right transverse sinus, as well as concurrent convexity DAVF and pial arteriovenous fistula over right vein of Labbé, all draining solely into right vein of Labbé. Anticoagulation therapy was discontinued due to aggressive nature of this DAVF. Transarterial embolization (TAE) with Onyx was performed in 2 sessions, achieving complete occlusion of shunt. Postoperatively, anticoagulation therapy was not resumed. Ten months later, the patient again experienced visual deterioration. Recurrence of convexity DAVF over right vein of Labbé was identified, and TAE with Onyx was performed again, resulting in successful shunt occlusion. Postoperatively, anticoagulant therapy was resumed. The patient's visual acuity gradually improved, and at 18 months post-treatment, no recurrence was observed. CVST following COVID-19 vaccination can progress to DAVF; therefore, careful follow-up is recommended.