Objective:

Scalp arteriovenous fistula (AVF) is a rare vascular condition when there is direct communication between scalp artery and vein without capillary bed in-between.  It could be congenital or secondary to prior injury such as trauma or head surgery. It often presented as a pulsating mass. Other associated symptoms and signs including pulsatile tinnitus, headache, hemorrhage, epilepsy and scalp necrosis.  There is only case reports or series and there is no standard treatment guidelines. Both intravascular embolization and surgical resection have been used in literature. 

Background:

The patient is a 40-year-old man with history of traumatic brain injury due to a snow mobile accident complicated with intracranial hemorrhage and left facial fracture. About a year later, he started to have generalized tonic-clonic seizures. His seizures are well controlled on Levetiracetam.  He presented with a new concern of a left-sided facial rash that seems to be getting more prominent overtime since the accident. There is no itchiness, pain, or numbness. He does sometimes hear a whooshing sound especially if he lays on the left side. 

Design/Methods:

On exam his left forehead is erythematous and blanchable. There is a prominent left temporal artery bruit. CT angiography of head and neck revealed a scalp arteriovenous fistula likely related to previous trauma. Digital subtraction angiography showed a large left scalp AVM supplied by multiple branches of superficial temporal artery (STA) and occipital artery. It was embolized with GLUE. Post-procedural angiography showed resolution of shunting. 

Results:

Conclusions:

Scalp AVF could be a late complication from head injury and could present as a facial rash. Physician should be familiar with possible associated symptoms. It could be successfully treated non-invasively by embolization.