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Eur J Neurol. 2016 Jul;23(7):1183-7. doi: 10.1111/ene.13031. Epub 2016 Apr 27.

Prognostic significance of pulsatile tinnitus in cervical artery dissection.

Author information

  • 1Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.
  • 2Department of Neurology, University Hospital, Ludwig-Maximilians University Munich, Munich, Germany.
  • 3Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Brescia, Italy.
  • 4Department of Neurology, Hôpital Lariboisière, Paris, France.
  • 5Department of Neurology, University Lille Nord de France, INSERM U1171, Lille, France.
  • 6Department of Epidemiology and Public Health, INSERM U744, Pasteur Institute, Lille, France.
  • 7Stroke Unit, Perugia University Hospital, Perugia, Italy.
  • 8Department of Neurosciences, Experimental Neurology - Laboratory of Neurobiology, VIB - Vesalius Research Centre, KU Leuven - University of Leuven, Leuven, Belgium.
  • 9Neurology, University Hospitals Leuven, Leuven, Belgium.
  • 10Cerebrovascular Unit, IRCCS Foundation C. Besta Neurological Institute, Milan, Italy.
  • 11Department of Neurology, University of Caen Basse Normandie, INSERM U919, Caen, France.
  • 12Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.
  • 13Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
  • 14Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.
  • 15Department of Neurology, Basel University Hospital, Basel, Switzerland.
  • 16Neurorehabilitation Unit, University Centre for Medicine of Aging and Rehabilitation, Felix Platter Hospital, Basel, Switzerland.



Our aim was to investigate whether pulsatile tinnitus (PT) in cervical artery dissection (CeAD) has prognostic significance.


All CeAD patients from the CADISP (Cervical Artery Dissection and Ischemic Stroke Patients) study with documentation of PT were analysed. The presence of PT was systematically assessed using a standardized questionnaire. Stroke severity at admission was defined according to the National Institutes of Health Stroke Scale (NIHSS). Excellent outcome after 3 months was defined as a modified Rankin Scale of 0-1.


Sixty-three of 778 patients (8.1%) reported PT. PT+ patients presented less often with ischaemic stroke (41.3% vs. 63.9%, P < 0.001), more often with dissection in the internal carotid artery (85.7% vs. 64.2%, P = 0.001), less often with vessel occlusion (19.0% vs. 34.1%, P = 0.017) and more often with excellent outcome at 3 months (92.1% vs. 75.4%, P = 0.002). Logistic regression analysis identified PT as an independent predictor of excellent outcome after 3 months [odds ratio (OR) 3.96, 95% confidence interval (CI) 1.22-12.87] adjusted to significant outcome predictors NIHSS on admission (OR 0.82, 95% CI 0.79-0.86), Horner syndrome (OR 1.95, 95% CI 1.16-3.29) and vessel occlusion (OR 0.62, 95% CI 0.40-0.94) and to non-significant predictors age, sex, pain and location of CeAD.


The presence of PT in CeAD is associated with a benign clinical course and predicts a favourable outcome.


acute ischaemic stroke; cervical artery dissection; outcome; pulsatile tinnitus

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