The Incidence of Cranial Arteriovenous Shunts in Patients With Pulsatile Tinnitus: A Prospective Observational Study
| Autor: | Frederick J. A. Meijer, J A de Laat, Peter W. A. Willems, Rolf Fronczek, Matthijs in ‘t Veld, Henricus P. M. Kunst |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Physical examination Arteriovenous malformation Lesion Arteriovenous Malformations 03 medical and health sciences Tinnitus 0302 clinical medicine Dural arteriovenous fistulas otorhinolaryngologic diseases medicine Humans Prospective Studies 030223 otorhinolaryngology Prospective cohort study Dural arteriovenous fistula Aged medicine.diagnostic_test business.industry Incidence Angiography Clinical features Digital subtraction angiography Middle Aged medicine.disease Sensory Systems Otorhinolaryngology Female Neurology (clinical) Radiology medicine.symptom Abnormality business 030217 neurology & neurosurgery Shunt (electrical) Rare cancers Radboud Institute for Health Sciences [Radboudumc 9] |
| Zdroj: | Otology & Neurotology, 39, 5, pp. 648-653 Otology and Neurotology, 39(5), 648-653 Otology & Neurotology, 39, 648-653 |
| ISSN: | 1537-4505 1531-7129 |
| Popis: | Item does not contain fulltext OBJECTIVES: Finding the underlying cause for pulsatile tinnitus can be challenging. We aimed to determine the incidence of arteriovenous shunts, i.e., arteriovenous malformations (AVMs) or dural arteriovenous fistulas (dAVFs), in patients referred for catheter angiography (digital subtraction angiography [DSA]). Furthermore, we assessed which clinical features were predictive for the presence of such a lesion. STUDY DESIGN AND METHODS: Fifty-one patients with pulsatile tinnitus, who were referred to us for DSA to exclude an arteriovenous shunt, were enrolled, prospectively. MAIN OUTCOME MEASURES: DSA determined the presence of a dAVF or AVM. Clinical characteristics were recorded systematically and all patients underwent a physical examination. RESULTS: Fifty patients were included in the final analyses. While no AVMs were found, a dAVF was found in 12 cases (24%). Three of these demonstrated cortical venous reflux, thus requiring treatment due to the risk of hemorrhage. In three cases (6%), DSA demonstrated a non-arteriovenous-shunt abnormality, likely causing the tinnitus. The odds of having a dAVF were significantly raised by unilaterality, objective bruit, and the ability to influence the tinnitus with compression. Unilaterality even had a negative predictive value of 1 and, if used as selection criterion, would have raised dAVF prevalence from 24 to 32%. CONCLUSION: In a tertiary care setting, the prevalence of dAVFs in patients with pulsatile tinnitus is not negligible. Thus, patients with unilateral pulsatile tinnitus should be offered dynamic vascular imaging to rule out a dAVF. Especially, since some of these patients are at risk of intracranial hemorrhage and treatment options exist. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|