Vascular Loop and Pulsatile Tinnitus: A Case Report

Aim: In 15% of patients with pulsatile tinnitus, no cause can be found. It has been proposed that compression of the auditory and vestibular nerve trunks by vascular loops might be the etiology of otherwise unexplained hearing loss, tinnitus, and vertigo. Our objective is to present the case of a woman with unilateral pulsatile tinnitus attributed to a vascular loop.

Material: A 47-year-old woman was seen in April 2006 with right pulsatile tinnitus, which had begun suddenly 4 months before. There were no associated symptoms such as hearing loss, vestibular symptoms, or facial nerve paralysis. There was also no history of ototoxic drug use, ear disease, head injury, or exposure to excessive noise.

Method: Otological and physical examinations were normal. She was normotensive. The full blood count excluded anemia. A blood test revealed hyperlipidemia. Pure tone audiometry and tympanometry were normal. Auditory brainstem evoked potentials (ABR) and electronystagmography (ENG) revealed no pathology. The carotid and vertebral triplex was normal. The patient was further evaluated with MRI brain scan with gadolinium and MR angiography which revealed a vascular loop in close association with her right eighth nerve.

Results and Conclusions: A vascular loop should be regarded as a cause of pulsatile tinnitus when any other possible etiology is excluded. Audiograms, ABR, ENG, and radiographic imaging all play a role in the diagnosis.