**6.2 Case 2**

A rare case of dural arteriovenous fistula at the cranio-cervical junction presented as cerebellar hemorrhage, which made physicians struggle with the diagnosis. A 77-year-old woman came to the emergency department complaining of dizziness, she had no history of arterial hypertension. A small cerebellar hemorrhage was revealed on imaging studies. Her diagnosis was hypertensive intracerebral hemorrhage and was treated conservatively. She developed subarachnoid hemorrhage 4 months later, and imaging studies detected dural arteriovenous fistula at the left C1 dural sleeve. Intracerebral hemorrhage and subarachnoid hemorrhage both occurred because of the disruption of a distended cerebellar vein due to venous hypertension caused by the dural arteriovenous fistula. Surgical ligation of a feeding artery and a draining vein was performed which cured the dural arteriovenous fistula [19].

#### **6.3 Case 3**

A report of delayed and progressive spontaneous closure of a DAVF after massive intracerebral hemorrhage documented by angiographic studies before and after bleeding. This is the first report to document gradual closure of a DAVF by serial angiographic studies. A 73-year-old woman who had an attack of generalized epileptic seizure was referred to a local hospital. Investigations like MRI and transfemoral cerebral angiography were done and revealed a DAVF Cognard type IIa + b of the left transverse sinus with feeders from the left occipital artery, left pharyngeal artery, left middle meningeal artery, and branches of the meningohypophyseal artery. There was reflux into the cerebral veins and the ipsilateral sigmoid sinus was not filled. She had conservative treatment and was discharged home on antiepileptic medications 3 days after admission. Also, she was planned a future endovascular therapy. She was admitted 1 week later after an episode of severe headache. Her neurological examination showed that her pupils were asymmetric and she was somnolent. A large and disseminated intracerebral hemorrhage in the left temporal, occipital, and parietal lobes was revealed on CT that was done upon admission. Her hematoma was evacuated surgically and she went through

decompressive craniotomy 2 days later to treat her generalized brain edema and increased intracerebral pressure refractory to conservative therapy. The patient was sent for rehabilitation for hemiparesis and her recovery was slow. The DAVF closed completely 8 weeks after the hemorrhage. One year after the bleeding the patient was followed up, she was independent and had recovered but with mild aphasia and a slight hemiparesis on the right side [20].
