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Pulsatile tinnitus caused by a dilated left petrosquamosal sinus
Dragoş Cătălin Jianu1, Silviana Nina Jianu, Traian Flavius Dan
1Department of Anatomy and Embryology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; amotoc@umft.ro.
Summary
A rare petrosquamosal sinus (PSS) caused pulsatile tinnitus and neurological symptoms in a postpartum woman. Prompt antithrombotic therapy led to sinus recanalization and symptom resolution.
Area of Science:
- Neurology
- Vascular Imaging
- Otolaryngology
Background:
- Emissary veins, including the petrosquamosal sinus (PSS), are rare valveless venous connections between intracranial dural sinuses and the extracranial venous system.
- These venous anomalies can rarely manifest as pulsatile tinnitus (PT).
Observation:
- A 22-year-old woman presented with worsening headaches, vomiting, diplopia, and exacerbated left-sided PT postpartum.
- Clinical examination revealed left sixth nerve palsy and temporomandibular joint sensitivity.
- High-resolution computed tomography (HRCT) identified an osseous canal consistent with PSS.
Findings:
- CT and MR venography demonstrated superior sagittal and left lateral sinus thrombosis.
- Laboratory tests indicated severe inherited thrombophilia.
- Antithrombotic therapy with heparin and warfarin resulted in rapid resolution of neurological symptoms and complete intracranial venous sinus recanalization within two weeks.
Implications:
- This case highlights the importance of considering PSS in the differential diagnosis of pulsatile tinnitus and neurological deficits, especially in the postpartum period.
- Early and effective antithrombotic treatment is crucial for favorable outcomes in patients with venous sinus thrombosis and associated conditions.
- Successful management underscores the potential for non-invasive medical therapy in resolving complex vascular and neurological complications.
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