skip to main content

Cranial Dural AV Fistula — SCE Neurology MCQ

Instant feedback + full explanation. One question, done properly.

HardCerebrovascular DiseaseCranial Dural AV FistulaSCE Neurology

A 50-year-old woman presents with a 3-month history of severe unilateral headache with ipsilateral tinnitus, hearing loss, and a cranial bruit audible to the examiner over the right mastoid process. CT angiography reveals a right transverse-sigmoid sinus dural arteriovenous fistula. What is the most appropriate treatment?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Endovascular embolisation

Cranial dural arteriovenous fistulae (dAVFs) with cortical venous drainage (Borden type II/III or Cognard type IIb and above) carry a risk of haemorrhage and require treatment. Endovascular embolisation (transarterial and/or transvenous) is the first-line treatment. Low-grade fistulae without cortical venous drainage may be observed. The pulsatile tinnitus and bruit are caused by high-flow arteriovenous shunting through the fistula. A: Not appropriate if there is cortical venous drainage or symptoms. C: Surgery is second-line if embolisation fails. D: Radiosurgery has a delayed effect. E: Anticoagulation does not treat dAVFs.

Reference: RCP National Clinical Guideline for Stroke (2023); Cognard Classification of dAVFs