Vertebro-vertebral fistula presenting as a pulsatile tinnitus

Abstract

Tinnitus is the perception of sound in the absence of a corresponding external acoustic stimulus, resulting in an estimated prevalence of 10% to 15% in adults. Tinnitus may be classified as pulsatile (PT) or continuous (non-PT), and may be subjective (heard only by the patient) or objective (also audible to the examiner). PT is usually related to vascular causes and is pulse synchronous (coinciding with the patient's heartbeat). PT is much less common affecting approximately 4% of patients with tinnitus, but unlike non-PT, usually has a specific identifiable cause. We present a case of a man without previous otological disease or head trauma, with a left-ear subjective PT. MR angiography detected a left vertebro-vertebral arteriovenous fistula, which was treated by endovascular embolisation with important symptomatic relief.

Keywords: ear, nose and throat/otolaryngology; interventional radiology.

Figure 1

MR angiography showing left vertebro-vertebral arteriovenous fistula (white arrow).

Figure 2

T1-weighted, axial MR. Flow void with left VVF and VA ectasia communicating by the VVF with the VV. Note the calibre diameter difference between the VA′ and VA, and the VV′ and the VV. VA, vertebral artery; VA′, normal vertebral artery; VV, vertebral vein; VV′, normal vertebral vein; VVF, vertebro-vertebral fistula.

Figure 3

Angiography showing left vertebro-vertebral fistula, with left vertebral artery ectasia.

Figure 4

Frontal view of the fistula. Note the circulation stop of left vertebral artery related to the turbulence of the fistula point (*).