Neuroimaging clinics of North America
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Tinnitus is a common symptom that usually originates in the middle ear. Vascular causes of pulsatile tinnitus are categorized by the location of the source of the noise within the cerebral-cervical vasculature: arterial, arteriovenous, and venous. Arterial stenosis secondary to atherosclerotic disease or dissection, arterial anatomic variants at the skull base, and vascular skull base tumors are some of the more common causes of arterial and arteriovenous pulsatile tinnitus. Noninvasive imaging is indicated to evaluate for possible causes of pulsatile tinnitus, and should be followed by catheter angiography if there is a strong clinical suspicion for a dural arteriovenous fistula.
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Neuroimaging Clin. N. Am. · May 2016
ReviewEndovascular Interventions for Idiopathic Intracranial Hypertension and Venous Tinnitus: New Horizons.
Pulsatile tinnitus from intracranial venous abnormalities is an uncommon cause of pulse synchronous tinnitus. Endovascular therapies may have applications in many of these disease conditions. ⋯ Venous stenting has been used successfully to treat venous stenoses with low complication rates and high success rates in patients with idiopathic intracranial hypertension though randomized controlled data are lacking. Careful exclusion of other causes of tinnitus should be performed before consideration for surgical or endovascular treatment of presumed causative lesions of venous tinnitus.
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Although tinnitus may originate in damage to the peripheral auditory apparatus, its perception and distressing symptomatology are consequences of alterations to auditory, sensory, and limbic neural networks. This has been described in several studies, some using advanced structural MR imaging techniques such as diffusion tensor imaging. ⋯ New MR imaging techniques enabling detailed depiction of the labyrinth may be useful when diagnosis of Meniere disease is equivocal. Advances in computed tomography and MR imaging have enabled noninvasive diagnosis of dural arteriovenous fistulae.
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Paragangliomas of the head and neck are rare vascular skull-base tumors derived from the paraganglionic system with an estimated incidence of 1:30,000 accounting for 3% of all paragangliomas. The most common paraganglioma locations of the head and neck in descending order are the carotid body, jugular, tympanic, and vagal paragangliomas. This article discusses the clinical characterics, normal anatamy, imaging findings and protocols, pathology, staging, and differential diagnosis for paragangliomas of the head and neck.
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Neuroimaging Clin. N. Am. · May 2016
ReviewVenous Abnormalities Leading to Tinnitus: Imaging Evaluation.
Venous anomalies are the most commonly identified abnormality by imaging in the work-up for pulse synchronous tinnitus. Potential diagnoses include idiopathic intracranial hypertension, sigmoid sinus wall anomalies, transverse and sigmoid sinus stenosis, jugular bulb anomalies, and prominent posterior fossa emissary veins. These causes are discussed in detail along with the association between sigmoid sinus wall anomalies and idiopathic intracranial hypertension.