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Post-traumatic pulsatile tinnitus: the hallmark of a direct carotico-cavernous fistula

Published online by Cambridge University Press:  13 February 2007

B Lerut ,
C De Vuyst ,
J Ghekiere ,
L Vanopdenbosch  and
R Kuhweide
B Lerut*
Affiliation:
Department of Otolaryngology, Az St Jan Hospital, Bruges, Belgium
C De Vuyst
Affiliation:
Department of Ophthalmology, Az St Jan Hospital, Bruges, Belgium
J Ghekiere
Affiliation:
Department of Neuroradiology, Az St Jan Hospital, Bruges, Belgium
L Vanopdenbosch
Affiliation:
Department of Neurology, Az St Jan Hospital, Bruges, Belgium
R Kuhweide
Affiliation:
Department of Otolaryngology, Az St Jan Hospital, Bruges, Belgium
*
Address for correspondence: Dr Bob Lerut, Ruddershove 10, 8000 Brugge, Belgium. Fax: 003250452290 E-mail: boblerut@gmail.com
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Abstract

Following trauma to her right frontal region, a 68-year-old woman suffered bilateral, benign, paroxysmal, positional vertigo and a left-sided, longitudinal petrosal bone fracture, with secondary facial palsy and ossicular luxation. From the onset, the patient complained of pulsatile, left-sided tinnitus. After eight weeks, she developed left-sided ocular symptoms, progressing from conjunctival hyperaemia and orbital oedema to an abducens nerve palsy, and ultimately to heart failure.

The case and the final diagnosis of carotico-cavernous fistula are discussed. Guidelines are proposed for a diagnostic approach to pulsatile tinnitus and for the optimal management of patients presenting with pulsatile tinnitus associated with ocular symptoms.

Keywords

Pulsatile TinnitusArteriovenous FistulaInternal Carotid ArteryCavernous Sinus
Type
Clinical Record
Information
The Journal of Laryngology & Otology , Volume 121 , Issue 11 , November 2007 , pp. 1103 - 1107
Copyright
Copyright © JLO (1984) Limited 2007

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Footnotes

Presented at the Royal Belgian Society of Otorhinolaryngology, Head & Neck Surgery, 20 May 2006, Leuven, Belgium.

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