title: Pulsatile tinnitus: a harbinger of a greater ill?
abstract: BACKGROUND
  Pulsatile tinnitus is an uncommon otologic symptom, which may be the presenting complaint of a potentially devastating pathology. Understanding this manifestation as a possible symptom of a significant vascular abnormality is crucial to guide management and treatment.
  
  
  RESULTS
  We describe a 38-year-old woman with sudden-onset right-sided pulsatile tinnitus. A right extracranial internal carotid artery (ICA) dissection was diagnosed with MRI/magnetic resonance angiography (MRA) and treated with anticoagulation. Follow-up MRI/MRA demonstrated complete resolution. Two months later, left-sided pulsatile tinnitus evolved. An MRI/MRA of the neck demonstrated left-sided extracranial ICA dissection. She was treated in a similar fashion and a repeat MRI/MRA demonstrated its resolution.
  
  
  CONCLUSIONS
  Spontaneous extracranial ICA dissection may present with pulsatile tinnitus as the only symptom in 4% to 50% of patients. Subsequent evolution of a contralateral dissection is even more uncommon. Generally, treatment of this phenomenon is conservative utilizing anticoagulation or aspirin; however, surgical intervention may be necessary.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA. liessb@health.missouri.edu
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Liess
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Lollar
authors.forename: Sidney G
authors.initials: SG
authors.lastname: Christiansen
authors.forename: Dale
authors.initials: D
authors.lastname: Vaslow
mesh_terms: D000328:Adult; D020215:Carotid Artery, Internal, Dissection / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D011859:Radiography; D012008:Recurrence; D014012:Tinnitus / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology