MemberP1495 Suddenly haunted by a turbulent heart beat in the right ear. Post-traumatic monolateral pulsatile tinnitus caused by cervical arteriovenous malformation: colour-Doppler ultrasound and angio-CT find
INTRODUCTION
Tinnitus, the perceived sensation of sound in absence of corresponding external acoustic stimulus, has a prevalence of 15% among adults [1]; it may impair quality of life in about 1-2% of cases. When pulsatile, objective and synchronous with heart beat, it may be secondary to vascular abnormalities [2]; in some patients a post-traumatic pathogenesis ( head and neck) has been reported, with a prevalence up to 10% .
CASE REPORT
We report the case of a 28 year old male patient with a history of a right side pulsatile tinnitus occurred three days after head trauma. Described as "hearing heart beat in the right ear as a turbulent sound", it corresponded with an audible bruit and palpable fremitus in latero-cervical region. History was negative for medical or surgical comorbidities as laboratory investigation; color Doppler ultrasound revealed an external carotid artery collateral- internal jugular vein fistula, resulting in a pulsatile turbulent flow, synchronic with heart beat.
Angio-CT scan of epiaortic vessels confirmed findings in the context of occipital articulation, near jugular foramen. Patient postponed further investigations for personal reasons.
DISCUSSION
Vascular post-traumatic lesions may cause post-traumatic pulsatile tinnitus. Symptom onset may be delayed from several days up to twelve weeks after trauma and it can be a sign of life-threatening disorders such as carotid cavernous fistulas, arteriovenous malformations, and carotid dissections [3 ] .
Clinical management includes basic diagnostic steps ( history, assessment of tinnitus severity, clinical ear examination, audiological and a neurovascular examination [2] . CT and MR with angiography, following colour-Doppler ultrasound , are used to determine the anatomical cause of vascular pulsatile tinnitus and to study surrounding structures. Angiography may be helpful for diagnosis and treatment planning [4].
CONCLUSIONS
Pulsatile tinnitus may occur after head and neck trauma, may affect quality of life and can be caused by live-threatening lesions. Arteriovenous fistulae between carotid artery branches and jugular vein may be treatable anatomical cause of symptoms, and have to be considered in differential diagnosis .
INTRODUCTION
Tinnitus, the perceived sensation of sound in absence of corresponding external acoustic stimulus, has a prevalence of 15% among adults [1]; it may impair quality of life in about 1-2% of cases. When pulsatile, objective and synchronous with heart beat, it may be secondary to vascular abnormalities [2]; in some patients a post-traumatic pathogenesis ( head and neck) has been reported, with a prevalence up to 10% .
CASE REPORT
We report the case of a 28 year old male patient with a history of a right side pulsatile tinnitus occurred three days after head trauma. Described as "hearing heart beat in the right ear as a turbulent sound", it corresponded with an audible bruit and palpable fremitus in latero-cervical region. History was negative for medical or surgical comorbidities as laboratory investigation; color Doppler ultrasound revealed an external carotid artery collateral- internal jugular vein fistula, resulting in a pulsatile turbulent flow, synchronic with heart beat.
Angio-CT scan of epiaortic vessels confirmed findings in the context of occipital articulation, near jugular foramen. Patient postponed further investigations for personal reasons.
DISCUSSION
Vascular post-traumatic lesions may cause post-traumatic pulsatile tinnitus. Symptom onset may be delayed from several days up to twelve weeks after trauma and it can be a sign of life-threatening disorders such as carotid cavernous fistulas, arteriovenous malformations, and carotid dissections [3 ] .
Clinical management includes basic diagnostic steps ( history, assessment of tinnitus severity, clinical ear examination, audiological and a neurovascular examination [2] . CT and MR with angiography, following colour-Doppler ultrasound , are used to determine the anatomical cause of vascular pulsatile tinnitus and to study surrounding structures. Angiography may be helpful for diagnosis and treatment planning [4].
CONCLUSIONS
Pulsatile tinnitus may occur after head and neck trauma, may affect quality of life and can be caused by live-threatening lesions. Arteriovenous fistulae between carotid artery branches and jugular vein may be treatable anatomical cause of symptoms, and have to be considered in differential diagnosis .
