Skip to main content Accessibility help

Post-traumatic pulsatile tinnitus: the hallmark of a direct carotico-cavernous fistula

  • B Lerut (a1), C De Vuyst (a2), J Ghekiere (a3), L Vanopdenbosch (a4) and R Kuhweide (a1)...


Following trauma to her right frontal region, a 68-year-old woman suffered bilateral, benign, paroxysmal, positional vertigo and a left-sided, longitudinal petrosal bone fracture, with secondary facial palsy and ossicular luxation. From the onset, the patient complained of pulsatile, left-sided tinnitus. After eight weeks, she developed left-sided ocular symptoms, progressing from conjunctival hyperaemia and orbital oedema to an abducens nerve palsy, and ultimately to heart failure.

The case and the final diagnosis of carotico-cavernous fistula are discussed. Guidelines are proposed for a diagnostic approach to pulsatile tinnitus and for the optimal management of patients presenting with pulsatile tinnitus associated with ocular symptoms.


Corresponding author

Address for correspondence: Dr Bob Lerut, Ruddershove 10, 8000 Brugge, Belgium. Fax: 003250452290 E-mail:


Hide All

Presented at the Royal Belgian Society of Otorhinolaryngology, Head & Neck Surgery, 20 May 2006, Leuven, Belgium.



Hide All
1Barrow, DL, Spector, RH, Braun, IF, Landman, JA, Tindall, SC, Tindall, GT. Classification and treatment of spontaneous carotid-cavernous sinus fistulas. J Neurosurg 1985;62:248–56
2Debrun, G, Lacour, P, Vinuela, F, Fox, A, Drake, CG, Caron, JP. Treatment of 54 traumatic carotid-cavernous fistulas. J Neurosurg 1981;55:678–92
3Robertson, A, Nicolaides, AR, Taylor, RH. Spontaneous carotico-cavernous fistula presenting as pulsatile tinnitus. J Laryngol Otol 1999;113:744–6
4de Keizer, R. Carotid-cavernous and orbital arteriovenous fistulas: ocular features, diagnostic and hemodynamic considerations in relation to visual impairment and morbidity. Orbit 2003;22:121–42
5Spector, RH. Echographic diagnosis of dural carotid-cavernous sinus fistulas. Am J Ophthalmol 1991;111:7783
6Schreiber, SJ, Diehl, RR, Weber, W, Henkes, H, Nahser, HC, Lehmann, R et al. Doppler sonographic evaluation of shunts in patients with dural arteriovenous fistulas. Am J Neuroradiol 2004;25:775–80
7Duan, Y, Liu, X, Zhou, X, Cao, T, Ruan, L, Zhao, Y. Diagnosis and follow-up study of carotid cavernous fistulas with colour Doppler ultrasonography: analysis of 33 cases. J Ultrasound Med 2005;24:739–45
8Weissman, JL, Hirsch, BE. Imaging of tinnitus: a review. Radiology 2000;216:342–9
9Willinsky, RA, Taylor, SM, TerBrugge, K, Farb, RI, Tomlinson, G, Montanera, W. Neurological complications of cerebral angiography: prospective analysis of 2,899 procedures and review of the literature. Radiology 2003;227:522–8
10Waugh, JR, Sacharias, N. Arteriographic complications in the DSA era. Radiology 1992;182:243–6
11Shin, EJ, Lalwani, AK, Dowd, CF. Role of angiography in the evaluation of patients with pulsatile tinnitus. Laryngoscope 2000;110:1916–20
12Brown, RD Jr, Flemming, KD, Meyer, FB, Cloft, HJ, Pollock, BE, Link, ML. Natural history, evaluation, and management of intracranial vascular malformations. Mayo Clin Proc 2005;80:269–81
13Link, MJ, Coffey, RJ, Nichols, DA, Gorman, DA. The role of radiosurgery and particulate embolization in the treatment of dural arteriovenous fistulas. J Neurosurg 1996;84:804–9
14Lockwood, AH, Salvi, RJ, Burkard, RF. Tinnitus. N Engl J Med 2002;347:904–10
15Sismanis, A. Pulsatile tinnitus. Otolaryngol Clin North Am 2003;36:389402, viii
16Waldvogel, D, Mattle, HP, Sturzenegger, M, Schroth, G. Pulsatile tinnitus – a review of 84 patients. J Neurol 1998;245:137–42


Post-traumatic pulsatile tinnitus: the hallmark of a direct carotico-cavernous fistula

  • B Lerut (a1), C De Vuyst (a2), J Ghekiere (a3), L Vanopdenbosch (a4) and R Kuhweide (a1)...


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed