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

Abstract

Tinnitus can be subclassified as either pulsatile or non-pulsatile based on the perceived quality of sound. Of them, pulsatile tinnitus (PT) is an auditory perception of heartbeat-synchronous sound, which is usually caused by vascular abnormalities. If PT is also audible by the examiner, it is also described as objective PT. Intracranial dural arteriovenous fistula (AVF) is one of the causes of PT. Dural AVF designates an abnormal direct connection between dural arteries and dural veins or a venous sinus, and accounts for approximately 10-15% of intracranial arteriovenous malformations. Dural AVFs are predominantly idiopathic, but a small percentage of patients have a history of previous craniotomy, trauma, or dural sinus thrombosis. The most common causes of traumatic AVFs are penetrating injuries to adjacent arteries and veins or iatrogenic sequelae of medical procedures. Diagnosis of traumatic AVFs are usually delayed for 2-6 months, because their clinical manifestations are quite variable and it takes time to be enlarged enough to emerge radiologically. Previous researchers have reported PT caused by traumatic AVF and its treatment. In most cases, tinnitus symptom occurred a few months after trauma, and there have been no reported cases of objective PT developed immediately after trauma by traumatic AVF. In the current study, we report a case of a traumatic AVF presenting as newly developed objective PT immediately after head Pulsatile Tinnitus due to Intracranial Dural Arteriovenous Fistula after Head Trauma by a Golf Ball