Magnetic resonance imaging (MRI) of Lan's brain at Tam Anh General Hospital, TP HCM, indicated a suspected dural arteriovenous fistula (dAVF) in the left transverse sinus region, accompanied by chronic thrombosis in the transverse sinus that had not yet caused complete occlusion. Doctor Duong Dinh Hoan, Head of the Neurointervention Unit at the Center for Diagnostic Imaging and Interventional Radiology, stated that persistent one-sided tinnitus can sometimes originate not from the ear but from abnormal blood flow in vessels near the ear and brain structures.

To precisely identify the blood flow path and the lesion's location, doctors ordered a digital subtraction angiography (DSA). DSA images revealed multiple abnormal arterial branches draining directly into the venous system in the left transverse sinus region, confirming the dural arteriovenous fistula.

According to Doctor Hoan, blood normally flows from arteries through the capillary system before returning to veins. When a fistula is present, high-pressure blood from the arteries flows directly into the venous system, altering pressure and flow direction.

In Lan's case, chronic thrombosis in the left transverse sinus simultaneously obstructed the venous blood outflow. The altered blood flow from artery to vein and the changed pressure within the venous system can generate sounds that the patient perceives as ringing, thumping, or pulsating in the ear, often more noticeable when lying still or at night.

Following a consultation, doctors decided to perform an endovascular intervention to close the fistula. Through a small vascular puncture, doctors guided a microcatheter system to the arterial branches feeding the fistula. Under DSA guidance, the team precisely located the abnormal connections, then introduced specialized materials to occlude the fistula.

Doctor Hoan performs a fistula embolization for Lan. Photo: Tam Anh General Hospital

Post-intervention DSA images confirmed the elimination of abnormal blood flow through the fistula. After the procedure, the patient's tinnitus decreased, and headaches improved. The patient was conscious, her health stable, and she was discharged after two days.

A dural arteriovenous fistula can manifest with atypical symptoms, among which persistent one-sided tinnitus is a notable sign, especially when the ringing follows the pulse rhythm.

Doctors advise individuals experiencing persistent one-sided tinnitus, tinnitus that follows the pulse, or accompanied by headaches, blurred vision, motor or sensory disturbances, or other abnormal neurological signs, to seek medical examination to determine the cause, rather than merely treating symptoms long-term.

Nhu Ngoc

* Patient's name has been changed