Pulsatile tinnitus was the only manifestation of internal carotid artery dissection
- PDF / 306,397 Bytes
- 2 Pages / 595.276 x 790.866 pts Page_size
- 90 Downloads / 190 Views
LETTER TO THE EDITOR
Pulsatile tinnitus was the only manifestation of internal carotid artery dissection Lizhang Chen 1 & Liyan Chen 2 & Yi Jiang 1 & Fayun Hu 1 & Li He 1 & Hongbo Zheng 1 Received: 24 May 2020 / Accepted: 6 October 2020 # Fondazione Società Italiana di Neurologia 2020
Case report A 49-year-old woman presented with left-sided pulsatile tinnitus for 1 month. She denied any medical history or medical treatment. Her blood pressure was normal. ENT (ear, nose, and throat) and neurological examinations were normal. The tinnitus could be decreased by compressing her left carotid artery. Complete blood count and thyroid function were both normal. Brain MRI was normal. Head and neck CT arterial angiography showed left distal cervical internal carotid artery (C1 segment) dissection with focal pseudoaneurysm, and the degree of stenosis was moderate to severe. The patient received 100 mg of aspirin and 75 mg of clopidogrel once a day for 1 month. The symptoms were not relieved, and the patient worried further ischemic symptoms. Then, the patient was treated by endovascular stenting (Fig. 1). The patient reported that the symptom disappeared after stenting, and she was discharged and continued antiplatelet therapy.
Discussion Pulsatile tinnitus is observed in 8.1–16% of patients with CAD [1–3] and is usually accompanied by other local signs or ischemic symptoms [4]. The case described here is unique since pulsatile tinnitus was the only manifestation of CAD, and the diagnosis might be missed or delayed. Lizhang Chen and Liyan Chen contributed equally to this work. * Hongbo Zheng [email protected] 1
Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
2
Department of Neurobiology Monitoring Center, West China Hospital, Sichuan University, Chengdu, China
In CAD, tinnitus is probably the result of the sound of turbulent blood flow being transmitted to the inner ear. However, it is difficult to prove that pulsatile tinnitus is due to CAD before stenting. Certain methods might be informative. First, compressing the carotid artery and the jugular vein is useful to distinguish whether the pulsatile tinnitus originates from an artery or venous sinus/veins [5]. Second, balloon occlusion testing is a useful technique to evaluate patients with pulsatile tinnitus and may help to identify patients who would benefit from surgery or intervention [6]. Third, retrievable Solitaire AB stent testing could identify patients who would benefit from stenting [7]. In our case, according to the Borgess classification [8], the patient’s carotid artery dissection was classified as type II B, and then the patient was treated using an endovascular technique based on the fact that type II B true healing was 0% in 6 months of follow-up [8]. In our case, we did not advocate balloon occlusion testing or retrievable Solitaire AB stent testing. The goal of endovascular stenting was to prevent further ischemic symptoms and treat tinnitus. The patient’s tinnitus disappeared after stenting, proving the causal re
Data Loading...
