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Post-traumatic pulsatile tinnitus: the hallmark of a direct carotico-cavernous fistula
B Lerut1, C De Vuyst, J Ghekiere
1Department of Otolaryngology, Az St Jan Hospital, Bruges, Belgium. boblerut@gmail.com
Abstract:
Following trauma to her right frontal region, a 68-year-old woman suffered bilateral, benign, paroxysmal, positional vertigo and a left-sided, longitudinal petrosal bone fracture, with secondary facial palsy and ossicular luxation. From the onset, the patient complained of pulsatile, left-sided tinnitus. After eight weeks, she developed left-sided ocular symptoms, progressing from conjunctival hyperaemia and orbital oedema to an abducens nerve palsy, and ultimately to heart failure. The case and the final diagnosis of carotico-cavernous fistula are discussed. Guidelines are proposed for a diagnostic approach to pulsatile tinnitus and for the optimal management of patients presenting with pulsatile tinnitus associated with ocular symptoms.
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