以單側姿態性搏動性耳鳴為表徵之中樞神經血管變異及內頸動脈彎曲

Vascular Variants of Central Nervous System and Tortuous Internal Carotid Arteries Presenting as Unilateral Positional Pulsatile Tinnitus

陳建志(Jiann-Jy Chen) ； 莊毓民(Yu-Ming Chuang) ； 楊菁華(Chin-Hua Yang) ； 陳登郎(Dem-Lion Chen)

《北市醫學雜誌》 6卷2期 (2009/04) Pp. 150-155

https://doi.org/10.6200/TCMJ.2009.6.2.08

摘要

大部分的耳鳴致病機制不明，若呈現與心跳同步的搏動時，需考慮腫瘤性或血管性的病灶。-39歲女性，因左側姿態性搏動性耳鳴3年多及高血壓1年，求診於本院。往往在低頭彎腰搬東西或夜間平躺，頭突然向左轉動時，就會出現病症。除了血壓高外，所有理學檢查、純音聽力檢查、心電圖及頸椎X光均為正常。頸部血管超音波顯示頸動脈之粥狀動脈硬化，無法偵測到右側椎動脈。合併血管造影之磁振造影顯示前交通動脈、兩側後交通動脈及右側椎動脈缺失，而兩側內頸動脈之顱外段各有一個大彎曲，診斷為中樞神經血管變異及內頸動脈彎曲，推測應是轉頭時造成椎動脈與頸動脈血流阻力變化，以及基底動脈血流減少引起心輸出量代償性地增加，造成姿態性搏動性耳鳴。建議必需長期控制血壓及服用抗血小板劑，並避免長時間頭向左轉。2週後，病症不再發作，血壓也已下降。經過半年的追蹤，情況依然穩定。

關鍵字

搏動性耳鳴 ； 前交通動脈 ； 後交通動脈 ； 椎動脈 ； 內頸動脈

並列摘要

Most of tinnitus is of unknown etiology. If it has pulsation the same as heartbeat, a neoplasm or vascular lesion should be impressed. A 39-yearold female presented left positional pulsatile tinnitus (PT) for over three years and hypertension for one year. The symptom has frequently attacked him when bending back or lying in the bed and then sudden head turning to the left side. All physical examinations, pure tone audiometry, electrocardiogram, and cervical spine X-ray showed normal, except high blood pressure. Neck duplex scanning showed atherosclerosis of carotid arteries, but right vertebral artery could not be detected. Magnetic resonance angiogram revealed lack of anterior communicating artery, bilateral posterior communicating artery, and right vertebral artery; besides, either of bilateral extracranial internal carotid arteries had a large tortuosity. Therefore, vascular variants of central nervous system and tortuous internal carotid arteries were diagnosed. The changed vascular resistance of his vertebral artery and carotid arteries, and decreased circulation of basilar artery, and compensatory increased perfusion of carotid arteries might cause PT when head turning to one side. Then an antihypertensive and an antiplatelet were recommended. Two weeks later, the symptom subsided and the blood pressure decreased. In the following half a year, it was uneventful.

並列關鍵字

pulsatile tinnitus ； anterior communicating artery ； posterior communicating artery ； vertebral artery ； internal carotid artery