Article
Dural Arteriovenous Fistula (DAVF) as cause of a pulse-synchronous tinnitus
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Authors
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Vasileios Bezas
- Klinikum Kassel/ENT, Kassel, Germany
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Ralf Siekmann
- Klinikum Kassel/Neuroradiology, Kassel, Germany
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Monika Hügens-Penzel
- Klinikum Kassel/Neuroradiology, Kassel, Germany
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Ulrike Bockmühl
- Klinikum Kassel/ENT, Kassel, Germany
| Published: | August 3, 2011 |
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Outline
Text
Introduction: A pulse- synchronous tinnitus could be caused in principle through vascular and not vascular processes.
Case report: We would like to report about a 46 year old female patient that she was complaining in the last 9 months about an insisted left side pulse-synchronous murmur with recurrent retroauricular pain. The otoscopy showed a clinical normal finding of the left tympanic membrane after a tympanoplasty type IIIb (PORP) because of a fixation of the middle ear ossicles. By the auscultation on the processus mastoideus could be heard a pulse-synchronous hissing stream noise, which was not transmitted in the carotids. The magnetic-resonance tomography has depicted a unilateral opacification of the mastoid and it was aroused the suspicion of a thrombosis in the sinus transversus area.
In the digital-subtraction-angiography (DAS) of the carotis externa artery revealed a dural arteriovenous fistula type I (classification according Merland, Djindjian and Cognard) on the left occipital side as well as smaller dural branches from carotis interna artery and occipitalis artery also on the left side.
From neuroradiological aspect the DAVF was embolised over the external branches superselective with PVA-particles between 150 und 500 µm. After that, gave the patient rare occurring headaches. The left side murmur was fast disappeared; it left only a retroauricular pulse on palpation.
Discussion: DAVF are considered the most often vascular causes of pulsatile tinnitus. Arteriovenous malformations or a raised stand of the bulbus venae jugularis are rare. Well vascularised tumors such as glomustumors or meningioms belong to the not vasculous causes.
The etiology of DAVF can be post-thrombotic or rather post- traumatic or idiopathic, although it is a matter of AV-short circuits between dural branches of the carotis externa-, carotis interna- and/or vertebralis-artery drainnings to the sinus transversus or sinus sigmoideus. Because of the clinic complain symptomatology and the possible intracranial hemorrhage, are exact diagnostics essential. There is therapeutic the possibility of a neurointerventional and/or neurochirurgical devascularisation, which aligns with clinical und angiographic criteria.
