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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.

Abstract

BACKGROUND AND PURPOSE:

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

METHODS:

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.

RESULTS:

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.

CONCLUSION:

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

KEYWORDS:

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

PMID:
27120261
DOI:
10.1111/ene.13031
[PubMed - in process]
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