Introduction: Dural arteriovenous fistulas (DAVF) are vascular lesions that require a high suspicious index for its diagnosis, because of their wide variety of clinical manifestations, moreover, invasive procedures such as digital subtraction angiogram (DSA) is the gold standard and is required for its diagnostic confirmation.

Clinical presentation: We report the case of a previously healthy 44-year-old young woman coming from the highlands of Peru, with the diagnosis of spontaneous intracranial hemorrhage, not treated at her local hospital. She was transferred to the capital city for complementary studies and possible treatment. DSA revealed a dural arteriovenous fistula, with feeder from the middle meningeal artery and venous cortical reflux, being catalogued as a Cognard grade IV/Borden III DAVF, we decided to perform an embolization of the fistulous communication with the non-adherent liquid embolic agent Onyx, with good clinical evolution. Immediate post embolization DSA and 6-month follow-up control DSA showed total absence of the fistula, being the patient catalogued as cured.

Conclusion: Initial diagnostic suspect, digital subtraction angiogram confirmation, an accurate study of the anatomy and the exact location of the fistulous communication are factors that favor the cure in these patients. The treatment in a specialized center that counts with the adequate infrastructure and with trained staff is vital to achieve cure.