• Yuhao Zhao, Yinmeng Qu, Ying Yu, Weikai Yao, Haiyang Xu, Jinlu Yu, and Xuan Chen.
• Department of Neurosurgery.
• Medicine (Baltimore). 2020 Oct 16; 99 (42): e22819.

IntroductionPial arteriovenous fistula (PAVF) is a rare intracranial vascular disease, and its presentation with a huge tumor-resembling thrombus is rarer.Patient ConcernsA 38-year-old female patient presented with a sudden left-side motor disorder and loss of consciousness. The patient was otherwise in good health and had no history of hypertension or diabetes. During the physical examination, she appeared lethargic and manifested left limb paralysis with level zero muscle strength and a positive pathological reflex.DiagnosesBecause imaging failed to rule out a tumor stroke, an intracranial lesion resection was performed immediately. Because the lesion was considered to be a vascular structure, digital subtraction angiography was undertaken before the surgery, and PAVF was diagnosed.InterventionsEndovascular embolization was conducted, followed by PAVF and hematoma resection.OutcomesAt the 3-month follow up, her left limb muscle strength was level 4, and she could live on her own (Modified Rankin Scale score = 2).ConclusionsIt is noteworthy that PAVF with a large thrombus may appear as a tumor in the initial diagnosis, and therefore it is necessary to perform an intracranial vascular examination in patients with tumor stroke symptoms.

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