以搏動性耳鳴爲表徵之顱內靜脈竇發育不全

Intra-cranial Venous Sinus Hypoplasia Presenting with Pulsatile Tinnitus

陳建志(Jiann-Jy Chen) ； 劉智仰(Chih-Yang Liu) ； 孫盛義(Sheng-Yih Sun) ； 陳登郎(Dem-Lion Chen)

《台灣耳鼻喉頭頸外科雜誌》 45卷6期 (2010/12) Pp. 190-194

https://doi.org/10.6286/2010.45.6.190

摘要

搏動性耳鳴與心跳同步時，需考慮腫瘤性或血管性的病灶。一60歲女性，因右側整日持續性耳鳴與日間搏動性耳鳴3年求診於本院，理學檢查及前庭功能檢查均無異常發現，聽力檢查顯示右側感覺神經性的聽障。血中膽固醇及三酸甘油酯值偏高。頸部血管超音波顯示右側推動脈血管阻力較左側高。合併血管造影之磁振造影顯示腦萎縮、左側顱內靜脈竇發育不全、前方威利氏環不完整及椎基底動脈彎曲。於是，診斷爲右側感覺神經性聽障、腦萎縮、中樞神經血管變異與高血脂症，建議服用抗焦應劑、抗血小板劑及腦代謝改善劑，並調整飲食及生活。1個月後，病症已大幅改善，經過半年的追蹤，情況依然穩定。應爲本個案之腦萎縮與右側感覺神經性聽障造成右側持續性耳嗚，右側顱內靜脈竇優勢與右側顱內堆勃脈成角彎曲造成右側搏動性耳嗚，處置以保守治療爲主，不僅症狀控制，並應設法降低血管阻力。

關鍵字

搏動性耳鳴 ； 靜脈竇發育不全 ； 椎基底動脈

並列摘要

If the rate of pulsatile tinnitus (PT) is the same as heart beats, a neoplasm or vascular lesion should be impressed. A 60-year-old female presented right whole-day persistent tinnitus and right daytime PT for three years. Physical examination and vestibular function test showed normal. Audiometry showed right sensori-neural hearing loss (SNHL). Blood examination showed hypercholesterolemia and hypertriglyceridemia. Neck duplex scanning showed a higher vascular resistance in the right vertebral artery than left. Magnetic resonance angiogram showed 1) brain atrophy. 2) left intracranial venous sinus hypoplasia, 3) defect of anterior circle of Willis, and 4) dolicho-tortuosity of vertebral-basilar artery. Therefore, right SNHL, brain atrophy, central vascular variants and hyperlipidemia were diagnosed. Anti-anxiety, antiplatelet, and brain activity promoter were recommended; besides, lifestyle and diet were changed. One month later, symptoms relieved much, and in the following half a year, it was uneventful. It is possible that brain atrophy and right SNHL led to right persistent tinnitus; besides, right intracranial venous sinus predominance and right intracranial vertebral artery angulation led to right PT. Conservative treatment was not only recommended to control symptoms, but also reduce the vascular resistance.

並列關鍵字

pulsatile tinnitus ； venous sinus hypoplasia ； vertebral-basilar artery