Disclosures: Anna M. Weingart: Nothing to disclose

Case Description: The patient is a 68-year-old female with a history of post-concussion syndrome after a fall in 2012 with loss of consciousness. Her primary symptoms included vertigo, headaches, anxiety, and impaired balance. Her symptoms intermittently improved with vestibular therapy and repeated Epley maneuvers. Six years later she had another concussion and experienced exacerbation of symptoms, which gradually improved, however was also reporting left ear tinnitus that was pulsatile in character. Physical examination in office did not show any focal neurological deficits or gross ear abnormalities. MRA brain revealed a left transverse and sigmoid sinus dural arteriovenous fistula.

Setting: Outpatient office

Patient: 68-year-old female with history of post-concussion syndrome presented with pulsatile tinnitus of left ear.  

Assessment/Results: Patient underwent uncomplicated coil embolization with interventional radiology with ultimate resolution of tinnitus and improvement in headaches after the procedure.

Discussion: Vestibular symptoms such as hearing loss, dizziness, vertigo, and tinnitus are common after a mild brain injury and fall under the diagnosis of labyrinthine concussion. Symptoms can occur even without radiologic evidence of injury to the labyrinth. In any patient with tinnitus and a history of concussion, post-concussion syndrome is high on the differential. However, it is important for providers to consider other possible causes. This is especially true for pulsatile tinnitus, which accounts for less than 10% of tinnitus patients and is often caused by vascular malformations.

Conclusion: Patients with post-concussion syndrome endorse a myriad of symptoms which may be sequela of prior brain injury, but providers must consider alternative etiologies of symptoms. In this case, work-up of pulsatile tinnitus in such a patient led to appropriate diagnosis and treatment of dural AV fistula and subsequent resolution of the patient’s symptoms.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/dural-av-fistula-presenting-as-pulsatile-tinnitus-in-patient-with-labyrinthine-concussion/