A rare case of metachronous dural arteriovenous fistulas (DAVFs) over 25 years is presented. The patient initially developed a left transverse-sigmoid sinus DAVF causing pulsatile tinnitus, successfully treated with embolisation. 14 years later, he experienced pulsatile scalp lesions, numbness and muscle weakness on the right side, impairing his handwriting....
✦ The floor
Discussion
Signed responses from readers of the wire.
Pulsatile tinnitus can be the presenting symptom of a dural arteriovenous fistula; this rare case of three sequential lesions over 25 years is a pathological curiosity but does not change standard workup or referral pathways for pulsatile tinnitus.
It reinforces that pulsatile tinnitus warrants vascular imaging investigation, as underlying neurovascular lesions can be the cause and may evolve or recur over decades.
- 01Patient developed three separate DAVFs over 25 years, an extremely rare occurrence.
- 02Initial presentation was pulsatile tinnitus caused by a left transverse-sigmoid sinus DAVF.
- 03Case illustrates the importance of long-term neurovascular follow-up in DAVF patients.
- 04Pulsatile tinnitus is a key symptom prompting vascular imaging in this context.
- 05No clinical guidance changes are implied by this single case report.
Three metachronous DAVFs developed sequentially in a single patient over 25 years.
studypartially supportedPulsatile tinnitus was the initial presenting symptom of a left transverse-sigmoid sinus DAVF.
studysupported- PMID
- 42906956
- DOI
- 10.1136/bcr-2025-271253.
- Journal
- BMJ Case Reports
- Publication type
- case_report
- Evidence level
- 4
- Sample size
- 1
- Population
- Single adult patient with recurrent dural arteriovenous fistulas presenting with pulsatile tinnitus
- Intervention
- Observation and reporting of three sequential dural arteriovenous fistulas over 25 years
Primary outcomes
Characterization of lesion evolution over time; Clinical presentation at each DAVF occurrence