To report a case of cerebral venous sinus thrombosis (CVST) in a patient on maintenance electroconvulsive therapy (ECT) complicated by dural arteriovenous fistula (dAVF).

ECT is considered to be an effective and safe treatment used mainly in patients with major depression. Common side effects are headache, muscle soreness, nausea, confusion, and memory impairment. Cardiovascular complications are well documented and are more common in patients with history of hypertension. There are a few case reports of reversible ischemia and intracerebral hemorrhage following ECT. To our knowledge CVST has not been reported in patients undergoing ECT. CVST has been suggested to play an important role in the pathogenesis of dAVF.

MRI brain with MR angiography and venography showed numerous punctate foci of petechial microhemorrhage in the left posterior temporal and occipital lobes, possible dAVF and non-occlusive thrombus within the left transverse sinus, left sigmoid sinus and left jugular bulb. Blood work showed no evidence of coagulopathy.  Imaging showed no evidence of malignancy.  Cerebral angiography confirmed left petrosal dAVF and CVST that were treated with transarterial embolization and anticoagulation with symptomatic improvement in her headache.

ECT causes an increase in cerebral blood flow and intracranial pressure; yet, cerebrovascular complications are not well known to occur. Our patient did not have any risk factors for CVST.  An association between CVST and ECT should be considered in patients without known risk factors. If not treated, CVST can result in formation of dAVF, which may cause life-threatening complications.