A 73-year-old woman suffering from end-stage renal disease due to glomerulonephritis and receiving HD through an arteriovenous fistula (AVF) in the left upper arm for 4 years presented with lightheadedness and alexia. Computed tomography showed a high-density area in the left occipital lobe, which was hypointense on T2 star weighted image of magnetic resonance imaging (MRI), and was diagnosed with subcortical hemorrhage [ and ]. T2-weighted image showed flow voids in the cerebellar hemispheres, left occipital lobe, left parietal lobe, and around the brainstem []. Magnetic resonance angiography (MRA) showed abnormal signals in internal jugular vein (IJV), sigmoid sinus, transverse sinus, inferior petrosal sinus, anterior condylar vein, and cavernous sinus such as dural AVF(dAVF) []. Head digital subtraction angiography (DSA) and venography through the arteriovenous graft were performed. DSA showed that the blood flow in the left cerebral hemisphere was mainly perfused through the right transverse sinus contralaterally [], but partially refluxed into cortical veins such as the vein of Trolard, leading to venous stasis and venous perfusion failure [ and ]. Shunt points on the dura were not observed. Venography showed occlusion of the left BCV and IVR through the IJV []. The development of the subcutaneous veins, which serve as collateral blood circulation to the contralateral side of the anterior neck and chest, was poor, and ectasia of the subcutaneous veins in the left upper arm and neck was observed. Based on these findings, we diagnosed subcortical hemorrhage due to IVR associated with the left BCV occlusion. Percutaneous transluminal angioplasty (PTA) for the left obstructive BCV was performed, but the obstructive lesion was only slightly improved [ and ]. Three weeks later, chemosis developed, so shunt ligation was performed. The chemosis disappeared the day after the operation and subcutaneous edema of the neck and the left upper arm also improved. MRI on the day after surgery showed complete disappearance of venous reflux []. Since then, neurological symptoms have not recurred.