Korean J Otorhinolaryngol-Head Neck Surg.  2015 Aug;58(8):589-593. 10.3342/kjorl-hns.2015.58.8.589.

Pulsatile Tinnitus due to Intracranial Dural Arteriovenous Fistula after Head Trauma by a Golf Ball

• Choi YJ
• Choi SI
• Song JJ
• Park JH

• KMID: 2141124
• DOI: http://doi.org/10.3342/kjorl-hns.2015.58.8.589

Abstract

Diagnosis of traumatic arteriovenous fistula (AVF) is usually delayed because it takes time to be enlarged enough to emerge radiologically or because symptoms occur a few months after the trauma. A 56-year-old woman presented with a newly developed tinnitus immediately after a head trauma. Pulsatile high-frequency tinnitus was heard also by examiner and recorded using a transcanal microphone. Angiography revealed an intracranial dural AVF fed by the middle meningeal artery, draining the superior sagittal sinus on the affected side. After percutaneous transarterial embolization, tinnitus successfully disappeared. The clinical presentation, radiologic and angiographic features, and management are discussed. To our knowledge, this is the first reported case of pulsatile tinnitus caused by AVF developed immediately after a trauma. We emphasize that precise physical examination, laboratory tests, and appropriate radiographic imaging are essential for accurate diagnosis and treatment when a patient presents with pulsatile tinnitus, especially after a head trauma.

Keyword

Arteriovenous fistula; Embolization; Pulsatile tinnitus

MeSH Terms

Angiography
Arteriovenous Fistula
Central Nervous System Vascular Malformations*
Craniocerebral Trauma*
Diagnosis
Female
Golf*
Head*
Humans
Meningeal Arteries
Middle Aged
Physical Examination
Superior Sagittal Sinus
Tinnitus*