Vertebro-vertebral arteriovenous fistulae occur infrequently.   We report on such a case with delayed presentation following penetrating neck injury.  This was successfully treated via coil embolisation. A 40-year-old woman presented with a subjective tinnitus that was abolished by turning her head to the right.  She had sustained penetrating neck trauma 6 months earlier.   Doppler Ultrasound and magnetic resonance angiogram confirmed the presence of a vertebral arterio-venous fistula.   Using a trans-femoral arterial approach, the left vertebral artery was embolised by deployment of multiple coils. The patient had no return of symptoms at 3 months follow up. Radiological diagnosis and endovascular management of this condition is discussed.