Prognostic significance of pulsatile tinnitus in cervical artery dissection.
Our aim was to investigate whether pulsatile tinnitus (PT) in cervical artery dissection (CeAD) has prognostic significance.



All CeAD patients from the CADISP (Cervical Artery Dissection and Ischemic Stroke Patients) study with documentation of PT were analysed. The presence of PT was systematically assessed using a standardized questionnaire. Stroke severity at admission was defined according to the National Institutes of Health Stroke Scale (NIHSS). Excellent outcome after 3 months was defined as a modified Rankin Scale of 0-1.



Sixty-three of 778 patients (8.1%) reported PT. PT+ patients presented less often with ischaemic stroke (41.3% vs. 63.9%, P < 0.001), more often with dissection in the internal carotid artery (85.7% vs. 64.2%, P = 0.001), less often with vessel occlusion (19.0% vs. 34.1%, P = 0.017) and more often with excellent outcome at 3 months (92.1% vs. 75.4%, P = 0.002). Logistic regression analysis identified PT as an independent predictor of excellent outcome after 3 months [odds ratio (OR) 3.96, 95% confidence interval (CI) 1.22-12.87] adjusted to significant outcome predictors NIHSS on admission (OR 0.82, 95% CI 0.79-0.86), Horner syndrome (OR 1.95, 95% CI 1.16-3.29) and vessel occlusion (OR 0.62, 95% CI 0.40-0.94) and to non-significant predictors age, sex, pain and location of CeAD.



The presence of PT in CeAD is associated with a benign clinical course and predicts a favourable outcome.
Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.|Department of Neurology, University Hospital, Ludwig-Maximilians University Munich, Munich, Germany.
L
L
Kellert
Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.
M
M
Kloss
Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Brescia, Italy.
A
A
Pezzini
Department of Neurology, Hôpital Lariboisière, Paris, France.|Department of Neurology, University Lille Nord de France, INSERM U1171, Lille, France.|Department of Epidemiology and Public Health, INSERM U744, Pasteur Institute, Lille, France.
S
S
Debette
Department of Neurology, University Lille Nord de France, INSERM U1171, Lille, France.
D
D
Leys
Stroke Unit, Perugia University Hospital, Perugia, Italy.
V
V
Caso
Department of Neurosciences, Experimental Neurology - Laboratory of Neurobiology, VIB - Vesalius Research Centre, KU Leuven - University of Leuven, Leuven, Belgium.|Neurology, University Hospitals Leuven, Leuven, Belgium.
V N
VN
Thijs
Cerebrovascular Unit, IRCCS Foundation C. Besta Neurological Institute, Milan, Italy.
A
A
Bersano
Department of Neurology, University of Caen Basse Normandie, INSERM U919, Caen, France.
E
E
Touzé
Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.|Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.|Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.
T
T
Tatlisumak
Department of Neurology, Basel University Hospital, Basel, Switzerland.
C
C
Traenka
Department of Neurology, Basel University Hospital, Basel, Switzerland.
P A
PA
Lyrer
Department of Neurology, Basel University Hospital, Basel, Switzerland.|Neurorehabilitation Unit, University Centre for Medicine of Aging and Rehabilitation, Felix Platter Hospital, Basel, Switzerland.
S T
ST
Engelter
Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.
T M
0000-0003-3425-0094
TM
Metso
Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.
C
C
Grond-Ginsbach
D000328:Adult; D002545:Brain Ischemia / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012737:Sex Factors; D020521:Stroke / Q000150:complications*; D014012:Tinnitus / Q000150:complications*; D020217:Vertebral Artery Dissection / Q000150:complications*
acute ischaemic stroke; cervical artery dissection; outcome; pulsatile tinnitus