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Prognostic significance of pulsatile tinnitus in cervical artery dissection

Journal article
Authors L. Kellert
M. Kloss
A. Pezzini
S. Debette
D. Leys
V. Caso
V. N. Thijs
A. Bersano
E. Touze
Turgut Tatlisumak
C. Traenka
P. A. Lyrer
S. T. Engelter
T. M. Metso
C. Grond-Ginsbach
Published in European Journal of Neurology
Volume 23
Issue 7
Pages 1183-1187
ISSN 1351-5101
Publication year 2016
Published at Institute of Neuroscience and Physiology
Pages 1183-1187
Language en
Links dx.doi.org/10.1111/ene.13031
Keywords acute ischaemic stroke, cervical artery dissection, outcome, pulsatile tinnitus, risk-factors, diagnosis, gender, Neurosciences & Neurology
Subject categories Clinical Medicine

Abstract

Background and purposeOur aim was to investigate whether pulsatile tinnitus (PT) in cervical artery dissection (CeAD) has prognostic significance. MethodsAll 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. ResultsSixty-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. ConclusionThe presence of PT in CeAD is associated with a benign clinical course and predicts a favourable outcome.

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