Journal of
eISSN: 2373-6410
Submit manuscript...
Case Report Volume 8 Issue 1
Spontaneous Intracranial Dural Arteriovenous Fistula in the Differential Diagnosis of Pulsatile Tinnitus
Joseph Bruno Bidin Brooks,1
Verify Captcha
Regret for the inconvenience: we are taking measures to prevent fraudulent form submissions by extractors and page crawlers. Please type the correct Captcha word to see email ID.
Mateus Reghin Neto,2 Guilherme Lopes da Silveira,3 Rodrigo André Oliveira,3 Eduardo de Almeida Guimarães Nogueira,4 Marcos Vinícius de Queiroz,4 Victor Perez Meireles de Souza,4 Celso Luis Silva de Oliveira,5 Juarez Harding,5 Fábio Prosdocimi6
Verify Captcha
Regret for the inconvenience: we are taking measures to prevent fraudulent form submissions by extractors and page crawlers. Please type the correct Captcha word to see email ID.
1Department of Neurology, Department of Function and Structure; UNIMES- Universidade Metropolitana de Santos, Brazil
2Institute of Neurological Sciences, Hospital Beneficencia Portuguesa de Sao Paulo, Brazil
3Clínica Mega Imagem, Brazil
4UNIMES- Universidade Metropolitana de Santos, Brazil
5Department of Neurology, Irmandade Santa Casa Misericórdia de Santos, Brazil
6Department of Function and Structure, UNIMES- Universidade Metropolitana de Santos, Brazil
Correspondence: Joseph Bruno Bidin Brooks, Irmandade Santa Casa de Misericórdia de Santos, Avenida Claudio Luiz da Costa 5, Santos, São Paulo, Brazil, 1175-9, Tel +55-13-32020600
Received: September 12, 2017 | Published: February 15, 2018
Citation: Brooks JBB, Neto MR, Silveira GLD, Oliveira RA, Nogueira EAG et al. (2018) Spontaneous Intracranial Dural Arteriovenous Fistula in the Differential Diagnosis of Pulsatile Tinnitus. J Neurol Stroke 8(1): 00280. DOI: 10.15406/jnsk.2018.08.00280
Keywords
Pulsatile tinnitus, Arteriovenous fistula, Case report
Introduction
Tinnitus is defined as the perception of a sound in the absence of a corresponding external source. According to the heart beat synchronization, it can present as Pulsatile Tinnitus (PT) and non-pulsatile Tinnitus (NPT). PT is difficult to diagnose, especially when otoscopy is normal, since the underlying etiology is not always clinically identifiable. Arteriovenous dural fistulas are rare abnormal connections between arteries and veins, corresponding to 10-15% of cerebral vascular malformations, and may initially manifest as PT.1,2
Methods
The report of this case was submitted and approved by the ethics committee of the Metropolitan University of Santos.
Case presentation
A 37-year-old man presented with a sudden onset, holocranial headache and left pulsatile tinnitus. The auscultation of the lateral portion of the neck identified a systolic murmur, more intense in the left mastoid region. Otoscopy, fundoscopy, clinical and laboratory examination were normal. History of trauma investigation was negative. Magnetic resonance imaging of the brain, angioresonance and digital subtraction angiography of intracranial vessels confirmed the presence of a dural arteriovenous fistula (Figure 1). The arterial vascular supply was made by cavernous branches of the left internal carotid artery and transverse branches of the left occipital artery, in addition to numerous dural branches from arteries of the contralateral carotid system. The venous drainage was precocious and towards the left transverse and sigmoid sinus into the internal jugular vein and suboccipital plexus in the same topography. The congenital abnormalities in the vascular anatomy of the cerebral arteriovenous transition are the main etiological cause imputed in this case. The patient underwent endovascular treatment with selective arterial embolization with occlusion of the fistulous path and satisfactory results.
Figure 1 A) Brain MRI (left), B) Angioresonance of intracranial vessels (middle) and C) Digital subtraction angiography (right) shows a complex dural arteriovenous fistula.
Conclusion
The presentation of this case alerts the possibility of spontaneous intracranial dural arteriovenous fistula in the differential diagnosis of pulsatile tinnitus. Attention to this clinical–radiologic correlation may help physicians make correct diagnoses and appropriate treatment.
Acknowledgments
None.
Conflicts of interest
None.
References
©2018 Brooks, et al. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.