Okada Tomohisa, Hamada Hiroaki, Tanaka Shunichi, Yamamoto Masaaki, Fujio Shingo, Hanaya Ryosuke, Arita Kazunori
Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Sakuragaoka, Kagoshima, Japan.
Department of Neurosurgery, Sakuradori Clinic, Izumi, Kagoshima, Japan.
NMC Case Rep J. 2025 Aug 27;12:349-354. doi: 10.2176/jns-nmc.2025-0089. eCollection 2025.
Spontaneous internal carotid artery dissection is a rare condition that generally affects middle-aged individuals. Most cases of reported spontaneous internal carotid artery dissections are unilateral, but approximately 10%-20% involve bilateral internal carotid arteries. Spontaneous internal carotid artery dissection generally presents with neck pain, ischemic cerebral symptoms, and/or Horner's syndrome. Pulsatile tinnitus is present in around 5%-10% of spontaneous internal carotid artery dissection cases. However, this is generally accompanied by other major internal carotid artery dissection symptoms. Herein, we report a case of bilateral spontaneous internal carotid artery dissection that presented with unilateral pulsatile tinnitus of sudden onset as an isolated symptom. An otherwise healthy 50-year-old man visited a neurosurgical clinic complaining of right temporal pulsatile tinnitus that had begun 1 day prior. In addition to tinnitus, a thorough symptom interview revealed mild heavy-headedness. Magnetic resonance angiography showed bilateral extracranial internal carotid artery dissections and severe stenosis of the true lumen of the right internal carotid artery. No cerebral ischemic lesions were observed. Administration of 5 mg/day amlodipine and 100 mg/day aspirin was initiated. Following the 9th day after onset, the pulsatile tinnitus gradually improved. Around the 40th day after onset, the pulsatile tinnitus disappeared, and magnetic resonance angiography showed an improvement of the right internal carotid artery stenosis. Magnetic resonance angiographies at 5 and 9 months after onset revealed complete disappearance of the false lumen and slight stenosis of the right internal carotid artery at the entrance of the carotid canal. This case suggests that the sudden onset of isolated unilateral pulsatile tinnitus can be a clue to the diagnosis of spontaneous internal carotid artery dissection.
自发性颈内动脉夹层是一种罕见疾病，通常影响中年个体。报道的自发性颈内动脉夹层多数病例为单侧，但约10%-20%累及双侧颈内动脉。自发性颈内动脉夹层一般表现为颈部疼痛、缺血性脑症状和/或霍纳综合征。搏动性耳鸣在约5%-10%的自发性颈内动脉夹层病例中出现。然而，这通常伴有其他主要的颈内动脉夹层症状。在此，我们报告一例双侧自发性颈内动脉夹层病例，该病例以突发的单侧搏动性耳鸣为孤立症状。一名50岁身体健康的男性因右侧颞部搏动性耳鸣前来神经外科门诊就诊，耳鸣始于1天前。除耳鸣外，详细的症状询问还发现有轻度头晕。磁共振血管造影显示双侧颅外颈内动脉夹层以及右侧颈内动脉真腔严重狭窄。未观察到脑缺血性病变。开始给予氨氯地平5毫克/天和阿司匹林100毫克/天。发病后第9天，搏动性耳鸣逐渐改善。发病后约第40天，搏动性耳鸣消失，磁共振血管造影显示右侧颈内动脉狭窄有所改善。发病后5个月和9个月的磁共振血管造影显示假腔完全消失，右侧颈内动脉在颈动脉管入口处有轻微狭窄。该病例提示，突发的孤立性单侧搏动性耳鸣可能是自发性颈内动脉夹层诊断的线索。
