Objective:To analyze the clinical presentation, potential pathogenesis, diagnosis, management and prognosis of dural arteriovenous fistula (DAVF) manifesting as bithalamic lesions.Methods:The clinical data of three patients with DAVF manifesting as bithalamic lesions from the First Affiliated Hospital of Xi'an Jiaotong University between August 2019 and August 2020 were analyzed retrospectively, and related literatures were reviewed.Results:Patient 1, a 56-year-old female, presented with a one-month aggressive clinical course of weakness, somnolence, nausea, vomiting, urine incontinence and sitting instability. Patient 2, a 53-year-old male, presented with a one-month aggressive clinical course of disturbance of consciousness, walking with difficulty and decreased higher cortex function. Patient 3, a 68-year-old male, presented with an eight-day aggressive clinical course of memory loss, disturbance of consciousness and mental symptoms. In these three patients, cranial computed tomography (CT) scans showed bilateral hypodensity shadow in thalamus while magnetic resonance imaging (MRI) demonstrated bithalamic edema. Magnetic resonance angiography (MRA) or computed tomography angiography (CTA) presented venous or venous sinus closely related with arteries. Digital substraction angiography (DSA) of the patient 1 demonstrated bilateral occipital artery-straight sinus DAVF treated with surgical excision. Four months later, the patient was consciousness with modified Rankin scale (mRS) score of 5. DSA of the patient 2 demonstrated DAVF supplied by the right external carotid artery and the symptoms were relieved after endovascular embolization. One year after operation, there was no recurrence and mRS score was 2. DSA of the patient 3 demonstrated occipital sinusional area DAVF treated with surgical excision. More than one year after surgery, the patient was conscious with mRS score of 5.Conclusions:DAVF-induced bithalamic lesions is a rare disorder in which clinical presentations are not specific.When cranial CT or MRI demonstrating bithalamic lesions, MRA or CTA showing venous or venous sinus closely related with arteries or presenting with disturbance of consciousness or cognitive decline, DAVF should be considered. DSA is the gold standard for diagnosis of DAVF. Endovascular embolization and surgical excision are the main treatments of DAVF.

Microglial surveillance plays an essential role in clearing misfolded proteins such as amyloid-beta, tau, and α-synuclein aggregates in neurodegenerative diseases. However, due to the complex structure and ambiguous pathogenic species of the misfolded proteins, a universal approach to remove the misfolded proteins remains unavailable. Here, we found that a polyphenol, α-mangostin, reprogrammed metabolism in the disease-associated microglia through shifting glycolysis to oxidative phosphorylation, which holistically rejuvenated microglial surveillance capacity to enhance microglial phagocytosis and autophagy-mediated degradation of multiple misfolded proteins. Nanoformulation of α-mangostin efficiently delivered α-mangostin to microglia, relieved the reactive status and rejuvenated the misfolded-proteins clearance capacity of microglia, which thus impressively relieved the neuropathological changes in both Alzheimer's disease and Parkinson's disease model mice. These findings provide direct evidences for the concept of rejuvenating microglial surveillance of multiple misfolded proteins through metabolic reprogramming, and demonstrate nanoformulated α-mangostin as a potential and universal therapy against neurodegenerative diseases.