Aristides Sismanis1, Alexander Girevendoulis. 1. Department of Otolaryngology-Head, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA. asismanis@aol.com
Abstract
OBJECTIVES: Internal carotid artery morphologic abnormalities mainly consist of tortuosities and coilings and can present with pulsatile tinnitus (PT). The purpose of this presentation is to report 3 representative cases and propose clinical and radiologic diagnostic criteria. PATIENTS: Three patients presenting with PT. INTERVENTION: Clinical evaluation including auscultation of the ear canal and head and neck. All patients underwent computed tomography angiography of the head and neck. MAIN OUTCOME MEASURES: Clinical evaluation, computed tomography angiography of the head and neck. RESULTS: Head bruit or objective tinnitus were detected in 2 patients. Symptoms of cerebral ischemia were absent. All patients were found to have tortuosities of the internal carotid arteries below the cranium base. One patient, in addition to tortuosity, had coiling as well. CONCLUSION: Morphologic abnormalities of the internal carotid artery may be associated with PT. Proper clinical evaluation coupled with computed tomography angiography of the head and neck can differentiate these abnormalities from other more serious vascular etiologies. Symptoms of cerebral ischemia warrant consultation with a vascular surgeon.
OBJECTIVES: Internal carotid artery morphologic abnormalities mainly consist of tortuosities and coilings and can present with pulsatile tinnitus (PT). The purpose of this presentation is to report 3 representative cases and propose clinical and radiologic diagnostic criteria. PATIENTS: Three patients presenting with PT. INTERVENTION: Clinical evaluation including auscultation of the ear canal and head and neck. All patients underwent computed tomography angiography of the head and neck. MAIN OUTCOME MEASURES: Clinical evaluation, computed tomography angiography of the head and neck. RESULTS: Head bruit or objective tinnitus were detected in 2 patients. Symptoms of cerebral ischemia were absent. All patients were found to have tortuosities of the internal carotid arteries below the cranium base. One patient, in addition to tortuosity, had coiling as well. CONCLUSION: Morphologic abnormalities of the internal carotid artery may be associated with PT. Proper clinical evaluation coupled with computed tomography angiography of the head and neck can differentiate these abnormalities from other more serious vascular etiologies. Symptoms of cerebral ischemia warrant consultation with a vascular surgeon.