Value of DSA in the Diagnostic Workup of Pulsatile Tinnitus

Deuschl, Cornelius; Göricke, Sophia; Gramsch, Carolin; Özkan, Neriman; Lehnerdt, Goetz; Kastrup, Oliver; Ringelstein, Adrian; Wanke, Isabel; Forsting, Michael; Schlamann, Marc

doi:10.1371/journal.pone.0117814

Cited by 21 publications

(18 citation statements)

References 22 publications

(31 reference statements)

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“…In agreement with Deuschl et al. 12 we reserve catheter cerebral angiogram for further assessment if concerning cerebrovascular pathology is seen on MRI.…”

Section: Discussionsupporting

confidence: 86%

Venous sinus stenting for the treatment of isolated pulsatile tinnitus: Results of a prospective trial

et al. 2020

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Objectives This prospective study evaluates the effectiveness and safety of venous sinus stenting for patients with isolated pulsatile tinnitus and lateral sinus stenosis. Methods Patients with isolated pulsatile tinnitus and lateral sinus stenosis with a minimum trans stenotic gradient of 4 mm Hg were treated with stenting. Pulsatile tinnitus before and after treatment was assessed with the Tinnitus Handicap Inventory (THI). Periprocedural adverse events, neurological complications, clinical and radiographic follow-up were also recorded. Results A total of 42 patients (41 females and 1 male) were included in the study (median age of 37.5 years). Thirty patients had post-stenotic fusiform and 12 had post-stenotic saccular venous sinus aneurysm. In addition to stenting, coils were used to treat the patients with saccular venous aneurysms. The median follow-up was 5 months (range 1 to 34 months). Most patients had complete (39/42) or near-complete (2/42) resolution of their pulsatile tinnitus post-procedure. There were no serious adverse events. Conclusion Stenting of the lateral venous sinus is a safe and effective treatment for patients with isolated pulsatile tinnitus due to venous sinus stenosis.

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“…In agreement with Deuschl et al. 12 we reserve catheter cerebral angiogram for further assessment if concerning cerebrovascular pathology is seen on MRI.…”

Section: Discussionsupporting

confidence: 86%

Venous sinus stenting for the treatment of isolated pulsatile tinnitus: Results of a prospective trial

et al. 2020

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“…Although MRA, including time-of-flightangiography, can provide valuable information on an AVF, some recent studies reported that susceptibility-weighted im- aging was also sensitive in detecting AVFs 10,13,16) . Nevertheless, cerebral angiography remains the gold standard for evaluating and classification of AVFs 4) . Traumatic AVFs between the MMA and MMV are uncommon because of the anatomical features of these structures 27) .…”

Section: Discussionmentioning

confidence: 99%

Endovascular Treatment of Traumatic Arteriovenous Fistula in Young Adults with Pulsatile Tinnitus

Kim

Song

et al. 2020

J Korean Neurosurg Soc

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Traumatic arteriovenous fistulas (AVFs) involving the external carotid artery are exceedingly rare in young adults. Since an AVF is the most common life-threatening cause for pulsatile tinnitus (PT), meticulous evaluation and treatment of patients with PT is crucial. Here, we present two traumatic AVF cases treated with coil embolization leading to no residual fistulous connections followed by an immediate and complete resolution of PT. A 20-year-old man developed left ear tinnitus three months after a traumatic brain injury involving the right temporal bone fracture. Cerebral angiography demonstrated an enlarged left middle meningeal artery (MMA) and a fistular point at the posterior branch of the MMA draining to the middle meningeal vein (MMV) and the left pterygoid plexus, suggesting an AVF. Another 18-year-old girl developed left tinnitus, left exophthalmos, and conjunctival injection 6 months after a traffic accident involving no demonstrable abnormal findings in the radiologic exam. Magnetic resonance angiography demonstrated a markedly dilated left MMA draining to the MMV, left cavernous sinus, and left superior ophthalmic vein. In both cases, coil embolization was performed with total obliteration of the fistular point. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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“…Tinnitus is defined as the perception of sound in the absence of a corresponding external acoustic stimulus and can be separated into non-pulsatile and pulsatile tinnitus. Pulsatile tinnitus is synchronous with the pulse17 and accounts for fewer than 10% of cases of tinnitus 18. It most commonly originates from vascular structures and can be separated into arterial and venous causes 19.…”

Section: Discussionmentioning

confidence: 99%

Pulsatile tinnitus as a presenting symptom of central venous stenosis secondary to an ipsilateral upper arm arteriovenous PTFE graft

Steele¹,

Flowers

Coles

et al. 2019

BMJ Case Rep

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A 51-year-old man presented with a swollen left arm and unilateral pulsatile tinnitus 2 weeks after a left upper arm polytetrafluoroethylene graft was created for haemodialysis access. A fistulogram of the left upper arm showed a central venous stenosis and significant retrograde flow up the left internal jugular vein. Percutaneous transluminal angioplasty was attempted unsuccessfully and fistula ligation was subsequently performed. This led to immediate resolution of the tinnitus. The venous stenosis was likely secondary to a cardiac resynchronisation therapy defibrillator, which had been removed 1 year previously. Central venous stenosis is a common but often asymptomatic complication of a cardiac device, with the exception of patients with upper extremity arteriovenous fistulas, who frequently develop symptomatic venous hypertension. This generally presents with ipsilateral arm swelling and/or high venous pressures during dialysis. To our knowledge, this is the first report of pulsatile tinnitus arising in this context.

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Value of DSA in the Diagnostic Workup of Pulsatile Tinnitus

Cited by 21 publications

References 22 publications

Venous sinus stenting for the treatment of isolated pulsatile tinnitus: Results of a prospective trial

Venous sinus stenting for the treatment of isolated pulsatile tinnitus: Results of a prospective trial

Endovascular Treatment of Traumatic Arteriovenous Fistula in Young Adults with Pulsatile Tinnitus

Pulsatile tinnitus as a presenting symptom of central venous stenosis secondary to an ipsilateral upper arm arteriovenous PTFE graft

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