- 期刊
Transverse Venous Sinus Stenosis Presenting with Persistent Pulsatile Tinnitus
以持續脈動性耳鳴為表徵之腦部橫靜脈竇狹窄
摘要
Pulsatile tinnitus arises from the passing of sounds through the inner ear as a result of turbulent blood flow within the vessels. These sounds are strongly related to the varying internal diameters of blood vessel segments. External force compression of the neck eliminates blood flow and intravascular pressure, reducing the pulsatile tinnitus. Common causes of pulsatile tinnitus include jugular bulb abnormalities, atherosclerotic disease, arteriovenous fistulas/malformations in the dural, skull base/ cervical region, internal carotid artery aneurysms and transverse sinus stenosis. This report concerns a 37-year-old female who presented with progressive left-sided pulsatile tinnitus for three months and a long history of headache. An MRI image revealed a stenotic site at the left transverse sinus and the venous phase of the carotid arteriogram showed a markedly reduced intensity of the left dural venous sinuses. The left-sided pulsatile tinnitus and headache improved following balloon angioplasty to re-establish the anterograde flow of the left transverse sinus. Since the image study is essential to the outcome of treatable pulsatile tinnitus, we demonstrate the presenting symptoms and specific radiological findings. In the treatment of patients with pulsatile tinnitus, transverse sinus stenosis may be considered as a differential diagnosis that requires further diagnostic image investigation.
並列摘要
當非層流的血流產生聲音傳至內耳，就會造成脈動式耳鳴，血管的內徑不規則度與脈動式耳鳴則有明顯的相關性，當壓迫頸部的血管時，此脈動式耳鳴會減少或是消失，比較常見之原因包含高頸靜脈球、頸動脈血管之粥狀硬化、腦部靜脈竇硬腦膜動靜脈瘻管、內頸動脈瘤以及腦部橫靜脈竇狹窄等。本病例報告提出一37歲女性，臨床表現為左側持續3個月之脈動式耳鳴及長期性之頭痛，腦部核磁共振檢查發現左側橫靜脈竇處較為狹窄，頸動靜脈血管攝影檢查於靜脈相時顯示左側橫靜脈竇、乙狀竇以及內頸靜脈的血流量明顯下降，因此施行經皮血管腔內血管成型術，使用氣球將血管窄縮處擴張以改善該處血流，術後病患左側耳鳴及頭痛皆有改善。因影像檢查對於治療極具重要性，我們在此提出此病患之特殊表現影像學發現。當治療脈動式耳鳴前，應將橫靜脈竇狹窄列為一鑑別診斷並安排相關影像檢查。