Learning objectives
To examine clinically-relevant neuroimaging anatomical variants of veins in the region of the temporal bones.
To apply this knowledge in a case-based approach pertaining to venous pulsatile tinnitus.
To review common and uncommon differential diagnoses of pulsatile tinnitus of venous origin.
Background
Pulsatile tinnitus is a perceived persistent sound synchronous with the heartbeat,
which can be unpleasant for patients.
There are many causes of pulsatile tinnitus,
of which vascular etiologies are the most common.
Although both arterial and venous etiologies have been implicated,
venous anatomical variants resulting in pulsatile tinnitus are more prevalent.
In this educational exhibit,
we review the venous anatomical variants and abnormalities occurring in the region of the petrous and mastoid portions of the temporal bones,
specifically with reference to their association to venous...
Findings and procedure details
Table of Contents of Venous Pulsatile Tinnitus:
1.Cerebral Dural Venous Sinus Neuroanatomy (Fig.
1)
2.Common Venous Etiology – Systemic:Intracranial Hypertension
3.Common Venous Etiologies –Dural Venous Sinus Related:
- High Riding Jugular Bulb
-Dehiscent Jugular Bulb
-Sigmoid Sinus Diverticulum
-Transverse Sinus Stenosis
4.Uncommon Venous Etiologies
-Enlarged Posterior Fossa Emissary Vein
- Dural Sinus Thrombosis
Common Venous Etiologies – Intracranial Hypertension
Idiopathic Intracranial Hypertension (IIH) is elevated intracranial pressure without evidence of mass or hydrocephalus.
Increased production of CSF,
impeded CSF absorption,
and increased vascular pressure have...
Conclusion
We review the clinically relevant venous anatomy and associated abnormalities in the setting of pulsatile tinnitus,
delving into both common and uncommon etiologies.
A sound understanding of venous anatomy,
variants,
and abnormalities in and around the petro-mastoid temporal bones is essential to diagnosing pulsatile tinnitus of venous origin.
References
1.
Reardon MA,
Raghavan P.
Venous Abnormalities Leading to Tinnitus: Imaging Evaluation.
Neuroimaging Clin N Am.
2016;26(2):237-245.
doi:10.1016/j.nic.2015.12.006.
2.
Dong C,
Zhao P-F,
Yang J-G,
Liu Z-H,
Wang Z-C.
Incidence of vascular anomalies and variants associated with unilateral venous pulsatile tinnitus in 242 patients based on dual-phase contrast-enhanced computed tomography.
Chin Med J (Engl).
2015;128(5):581-585.
doi:10.4103/0366-6999.151648.
3.
Pegge SAH,
Steens SCA,
Kunst HPM,
Meijer FJA.
Pulsatile Tinnitus: Differential Diagnosis and Radiological Work-Up.
Curr Radiol Rep.
2017;5(1):5.
doi:10.1007/s40134-017-0199-7.
4.
Alqahtani B,
Alsherhri H,
Alqahtani M.
Dilated...