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28.06.2014

Pulsatile tinnitus brain aneurysm, treatment for temporary tinnitus - Review

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Inner ear disorders that increase hearing sensitivity (such as SCD) can cause pulsatile tinnitus.
Cerebral angiography is a form of angiography which shows images of blood vessels in and around the brain, thereby allowing detection of abnormalities such as aneurysms, arteriovenous malformations, fistulas, and tumors. Typically a catheter is inserted into a large artery (such as the femoral, brachial, or radial artery) and threaded through the circulatory system to the carotid, vertebral, or subclavian artery, where a contrast agent (dye) is injected. The term stroke, or cerebrovascular accident (CVA), is a broad term generally indicating a sudden neurologic deterioration secondary to one of two etiologies: 1) a clot in one of the arteries supplying flow to the brain, or an “ischemic stroke”, or 2) bleeding into the brain. An intracranial aneurysm (also called cerebral aneurysm or brain aneurysm) is a cerebrovascular disorder in which weakness in the wall of a cerebral artery causes a localized outpouching or ballooning of the blood vessel.
If an aneurysm ruptures, blood leaks into the thin coverings of the brain called the subarachnoid space.
Arteriovenous malformations (AVMs) and arteriovenous fistulas (AVFs) occur when an abnormal connection develops between arteries and veins in the brain or dura (i.e. A brain AVM is an abnormal connection between the cerebral arteries and veins, bypassing the capillary system, located within the brain parenchyma.
Whether it is the mechanical retrieval of a thromboembolic occlusion of a blood vessel in the brain or medical dissolution of a blood clot using direct infusion of medicine at the clot face, large vessel occlusions responsible for symptoms of acute stroke may be treated with interventional neuroradiology, as an adjunct to intravenous tPA (clot buster) administration, which is the current standard of care.


Flow restoration may rapidly re-establish oxygen supply in the brain region that has been deprived of oxygen and nutrients that the blood. Particularly advantageous is that the stent is applicable repeatedly and can be used even in small peripheral brain blood vessel branches (eg, M2 segments). The carotid arteries are blood vessels in the neck that circulate oxygenated blood and nutrients from the heart to the brain. Idiopathic intracranial hypertension (IIH), sometimes called by the older names benign intracranial hypertension (BIH) or pseudotumor cerebri (PTC), is a neurological disorder that is characterized by increased intracranial pressure (pressure around the brain) in the absence of a tumor or other disease. The symptoms are headache, nausea, and vomiting, and sometimes pulsatile tinnitus (buzzing in the ears synchronous with the pulse), diplopia (double vision) and other visual symptoms. Older treatments of IIH included repeat lumbar punctures, medications that decrease production of CSF, surgical decompression of the optic nerve (optic nerve sheath fenestration), surgical shunting of the CSF from the spine to the abdomen (lumboperitoneal shunt), CSF shunting from the brain to the abdomen (ventriculoperitoneal shunt), and even CSF shunting from the brain to the heart (ventriculoatrial shunt).
Various tumors in the brain, head, neck, and spine can be treated pre-operatively with embolization to reduce the risk of bleeding during open surgery. A series of radiographs are taken as the contrast agent spreads through the brain’s arterial and venous systems. If, for example, the images reveal an aneurysm, metal coils may be introduced through the catheter already in place and maneuvered to the site of aneurysm; over time these coils encourage formation of connective tissue at the site, strengthening the vessel walls.


Currently available devices are able to be navigated through the arteries in the neck and brain to retrieve or aspirate clots and remove large blockages that may not dissolve with intravenous tPA administration. Although many AVMs are asymptomatic, AVMs in the brain can cause headache, intracranial bleeding, and lead to other serious neurologic problems, such as seizures. The carotid arteries are located anteriorly on both sides of your neck and carry blood to the majority of the brain.
An embolization protection device may be used during the procedure to prevent the atherosclerotic plaque from the narrowed vessel wall from migrating to the brain during the procedure and causing symptoms of stroke. Accordingly, other possibilities for vascular tinnitus include dehiscence (missing bone) of the jugular bulb -- an area in the skull which contains the jugular vein, and an aberrantly located carotid artery.
The vertebral arteries are the smaller, more posteriorly located arteries located on both sides of your neck that carry blood to the back of the brain and brainstem. An enlarged jugular bulb on the involved side is common in persons with venous type pulsatile tinnitus.



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