Sigmoid sinus dural arteriovenous fistula presenting with pulsatile tinnitus in the postpartum period: A case report

Pregnancy and the postpartum period are acknowledged as potential risk factors for cerebrovascular disease. Nonetheless, dural arteriovenous fistulas (DAVFs) identified during the postpartum period have been infrequently documented. A 31-year-old woman with no prior medical history experienced sudden-onset pulsatile tinnitus in the left ear immediately following childbirth. Time-of-flight magnetic resonance angiography revealed a high-signal intensity lesion surrounding the left sigmoid sinus. Subsequent cerebral angiography demonstrated a left-sided sigmoid sinus dural arteriovenous fistula draining into the left sigmoid sinus, with antegrade venous flow and retrograde reflux into the contralateral transverse sinus, but without cortical venous reflux. Transarterial embolization was successfully performed, resulting in complete resolution of the tinnitus. We propose that hormonal fluctuations and hemodynamic changes, including elevated venous pressure associated with pregnancy and the postpartum period, may contribute to the development of DAVFs.