Post-traumatic pulsatile tinnitus: the hallmark of a direct carotico-cavernous fistula.
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.
Lerut
B
B
Department of Otolaryngology, Az St Jan Hospital, Bruges, Belgium. boblerut@gmail.com
De Vuyst
C
C
Ghekiere
J
J
Vanopdenbosch
L
L
Kuhweide
R
R
D000368:Aged; D000792:Angiography; D021721:Balloon Occlusion; D020216:Carotid-Cavernous Sinus Fistula / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D005128:Eye Diseases / Q000000981:diagnostic imaging / Q000209:etiology; D005158:Facial Paralysis / Q000209:etiology; D005260:Female; D006801:Humans; D010579:Petrous Bone / Q000293:injuries*; D012887:Skull Fractures / Q000150:complications*; D014012:Tinnitus / Q000209:etiology*; D014717:Vertigo / Q000209:etiology