加载中…2015年01月01日
(2015-01-01 00:34:48)
A 33-year-old woman presented with right-sided pulse synchronous
tinnitus. The noise began seven months prior to admission and
became constant after a month. Upon admission, the patient
complained of a recent increase in sound intensity, with occasional
pain in the right ear, which was intermittently severe. There was
no sign of hypertension, although the patient was moderately obese.
On physical examination, a pulse synchronous bruit was heard best
behind the right ear. The pitch increased with Valsalva and the
sound level decreased with ipsilateral neck compression. An outside
magnetic resonance angiography (MRA) was interpreted to be
suspicious for a dural arteriovenous fistula, with prominence of
the right transverse sinus and prominent branches of the occipital
artery visualized in the scalp (Fig. 3a).
Angiography performed in June 1993 failed to reveal any arterial abnormality. The right occipital artery was prominent, as seen on the MRA, but was otherwise normal. In the venous phase, the right transverse and sigmoid sinuses were dominant and there was moderate narrowing of the mid-right transverse sinus (Fig. 3b), directly under the audible bruit.
No surgical intervention was undertaken. Follow-up six months later revealed no interval change in the noise, which remained loud enough to interfere with hearing in the right ear, to the point that the patient would turn her head to the opposite side to hear better.
http://www.tinnitusjournal.com/imagebank/images/v1n2a10-fig03a.jpg
Figure 3a. Collapsed view of MR angiogram (basal projection) clearly shows a normal Circle of Willis. No arterial abnormalities are seen. Note some prominence of scalp branches of the occipital artery (arrows) and relatively rapid flow (high signal) in the right transverse sinus (white arrows).
Figure 3a. Collapsed view of MR angiogram (basal projection) clearly shows a normal Circle of Willis. No arterial abnormalities are seen. Note some prominence of scalp branches of the occipital artery (arrows) and relatively rapid flow (high signal) in the right transverse sinus (white arrows).
Angiography performed in June 1993 failed to reveal any arterial abnormality. The right occipital artery was prominent, as seen on the MRA, but was otherwise normal. In the venous phase, the right transverse and sigmoid sinuses were dominant and there was moderate narrowing of the mid-right transverse sinus (Fig. 3b), directly under the audible bruit.
http://www.tinnitusjournal.com/imagebank/images/v1n2a10-fig03b.jpg
Figure 3b. Venous phase of carotid arteriogram reveals moderate narrowing of the mid-right transverse sinus, (arrows), just beneath the audible bruit observed clinically.
Figure 3b. Venous phase of carotid arteriogram reveals moderate narrowing of the mid-right transverse sinus, (arrows), just beneath the audible bruit observed clinically.
No surgical intervention was undertaken. Follow-up six months later revealed no interval change in the noise, which remained loud enough to interfere with hearing in the right ear, to the point that the patient would turn her head to the opposite side to hear better.
喜欢
0
赠金笔
前一篇：2015年01月01日
后一篇：2015年01月01日