This case demonstrates a patient presenting with spontaneous intracranial hemorrhage that on further MRI investigation showed to be related to a dural arteriovenous fistula. Angiography has confirmed and better characterized the that as a high-grade dural arteriovenous fistula, directly into a leptomeningeal vein, with a venous aneurysm and varicosity, also with a paradoxical supply from beneath the tentorium from PICA. 

The patient then was treated surgically and complete exclusion of the dural AVF from the circulation has been confirmed on the last angiogram.

Angiography images courtesy of the RMH radiology neuro intervention team.