To present a rare case of transverse-sigmoid Dural AVF presented with pulsatile tinnitus following trauma to the head and face.

Dural arteriovenous fistula (dAVF) is a relatively rare type of cerebrovascular malformation with unknown pathogenesis. However, trauma can influence dAVF formation by creating a direct fistula between dural arteries and neighboring sinuses or cortical veins. Transverse/sigmoid sinus Dural arteriovenous fistula (TsdAVF) can present with isolated pulsatile tinnitus. Acute dAVF following trauma are rare lesions but tend to occur within 48 hours of the injury. Left untreated, TSdAVF may result in catastrophic outcomes. 

The patient was identified in routine clinical practice.

A 45-year-old Male presented with a complaint of pulsatile tinnitus on the right side that started after one month following trauma to the head and face during a fight. Tinnitus was reducible on compression of the right mastoid region. He denied any other neurological symptoms. He underwent a diagnostic cerebral angiogram which revealed the presence of a high-flow dAVF grade Cognard 2A &B in the area of the right transverse-sigmoid sinus. He underwent trans venous coil embolization of a dural AV fistula on the right transverse sigmoid sinus and was discharged to home. On follow-up after 3 weeks, the patient endorsed the complete resolution of tinnitus. 

This case highlights isolated pulsatile tinnitus following trauma which can be missed during regular examination. A timely diagnosis and intervention can help to avoid the complications of dAVF.