Arteriovenous fistula of superficial temporal vessels

We present a case of patient with a rare vessel pathology - arteriovenous fistula (AVF) of superficial temporal artery and vein. The 56-year-old man was admitted to the Department of Neurology because of a headache in the right temporal region with concomitant buzzing sound in his right ear. The pain was present mainly in the evenings and was stronger when touching the temporal region. He denied having any head injury in the last few years. There were no signs of central nervous system involvement in the neurological examination. Within the right temporal area a subcutaneous mass with redness of the surrounding skin and with palpable and audible pulsatile thrill was observed. In computed tomography (CT) of the head no abnormalities were found. In duplex-Doppler ultrasound examination of carotid arteries the systolic blood velocity in the right external carotid artery was over two times higher than in the left one. Its flow profile was turbulent and low-resistant. In CT angiography (CTA) an AVF between superficial temporal artery and vein was revealed - it was located at the level of the right zygomatic arch. In both CTA and magnetic resonance angiography, no abnormal connections between extra- and intracranial vessels were found. The patient underwent surgery with good result - all the symptoms disappeared. AVFs of vessels of the scalp are rare and their aetiology is mainly traumatic or iatrogenic. By describing this case we wanted to draw attention to less frequent causes of headache.