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Medial left frontal intraparenchymal hemorrhage and bilateral intraventricular hemorrhage (angiography)

(A) 38-year-old man with medial left frontal intraparenchymal hemorrhage and bilateral intraventricular hemorrhage. Two cerebral angiograms, head CTA and head MRI head without and with gadolinium during the initial hospitalization were unremarkable. (B) Angiography 3 months later (left internal carotid artery injection, left transorbital oblique view) demonstrates an anterior cranial fossa dural arteriovenous fistula (black arrow) supplied by the ipsilateral anterior falcine artery (white arrow). There is early retrograde leptomeningeal venous drainage into a left frontal cortical vein (double black arrows) and then into the superior sagittal sinus (double white arrows). (Contributed by Dr. Jose Biller.)