![]() ![]() Typically seen in young female patients with morbid obesity Otoscopy shows a beefy red mass behind the anteroinferior quadrant of the tympanic membrane Pulsating rhythm of bruit similar to patient’s pulse ![]() History of trauma, surgery, infection or intracranial neoplasmīruit auscultated over skull in the area behind the ear Ipsilateral carotid bruit or thrill heard in patient’s neckĪrteriovenous fistula and arteriovenous malformation Because we thought that the fistula might rupture and cause a cerebral hemorrhage, we referred her for urgent consultation with a neuro-surgeon, who recommended a diagnostic catheter angiogram to document the anatomy of the fistula. There was also evidence of diffuse dural enhancement consistent with venous hypertension ( Figures 1 and and2). Magnetic resonance imaging showed a dural arteriovenous fistula on the patient’s left side, with prominent arterial supply from the left middle meningeal and left occipital arteries. There was no enhancing vascular mass and no evidence of herniation of the brainstem. We did not hear any such sounds over her neck, and the rest of the examination of her head and neck yielded normal results.Ī computed tomography (CT) scan of the head showed a prominence in our patient’s left cavernous sinus. ![]() The bruit was more prominent when we asked the patient to turn her head to the left. Given the patient’s history of unilateral, pulsatile tinnitus, we auscultated her skull and heard a soft, high-pitched bruit over her left mastoid process. Findings on otoscopy and examination of the cranial nerves were unremarkable. The patient was in no distress and appeared to be otherwise healthy. She had no history of head trauma, surgery, hypertension or cardiovascular disorders. A 67-year-old woman presented with a constant, pulsatile, ringing in her left ear that had been ongoing for 12 months. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |