Pelkonen Outi, Tikkakoski Tapani, Luotonen Jukka, Sotaniemi Kyösti
Department of Diagnostic Radiology, Oulu University Hospital, Finland.
J Laryngol Otol. 2004 Mar;118(3):193-8. doi: 10.1258/002221504322927955.
The aim of this study was to investigate pulsatile tinnitus as a presenting symptom in cervicocephalic arterial dissection (CCAD). Of the 136 consecutive patients with confirmed CCAD, 16 presented with pulsatile tinnitus. On admission 10 patients presented with subjective tinnitus and five with objective tinnitus, tinnitus being the only presenting symptom in one case. In one further case with bilateral ICA dissection (ICAD) subjective tinnitus appeared three months after the initial symptoms of arterial dissection, despite a contralateral cervical bruit being evident on admission. Thirteen patients presented with headache or neck pain. Ischaemic symptoms were detected in six and Horner's syndrome in four patients. Vertigo and dysgeusia were reported in two patients each. Arterial dissection involved unilateral ICA in 11, bilateral ICA in two, unilateral vertebral artery (VA) in two and bilateral ICA and bilateral VA in one patient. In angiography the most common finding was irregular stenosis, and the majority of these abnormalities normalized during follow-up. To avoid delay in diagnosis a high index of suspicion and early angiography (digital subtraction or magnetic resonance angiography) are warranted.
本研究旨在调查搏动性耳鸣作为颈脑动脉夹层（CCAD）的一种表现症状。在连续136例确诊为CCAD的患者中，16例出现搏动性耳鸣。入院时，10例患者表现为主观性耳鸣，5例表现为客观性耳鸣，其中1例耳鸣是唯一的表现症状。在另一例双侧颈内动脉夹层（ICAD）患者中，尽管入院时对侧颈部有明显杂音，但在动脉夹层初始症状出现三个月后出现了主观性耳鸣。13例患者出现头痛或颈部疼痛。6例检测到缺血症状，4例出现霍纳综合征。眩晕和味觉障碍各有2例报告。动脉夹层累及单侧颈内动脉11例，双侧颈内动脉2例，单侧椎动脉（VA）2例，双侧颈内动脉和双侧椎动脉1例。血管造影最常见的表现是不规则狭窄，这些异常大多数在随访期间恢复正常。为避免诊断延误，需要高度怀疑并早期进行血管造影（数字减影或磁共振血管造影）。
