以搏動性耳鳴為表現之頸部內側頸動脈瘤：病例報告

Cervical Internal Carotid Artery Aneurysm Presented as Pulsatile Tinnitus: A Case Report

搏動性耳鳴是一種少見但嚴重的症狀且常有明確病因。搏動性耳鳴之病人可能患有嚴重的潛在性疾病，如內側頸動脈瘤。因現時缺實證醫學為基礎的治療指引，醫師在治療頸動脈瘤時面臨困境和挑戰。本文報告一位高血壓病患，最初以左側搏動性耳鳴為表現，經詳細病史詢問、理學檢查及放射影像檢查後，診斷為雙側內頸動脈動脈瘤，左側明顯較大。病人在服用三種降血壓藥物和預防腦栓塞(aspirin)，血壓可控制在目標值（低於130/80 mmHg）後，便無出現搏動性耳鳴的症狀；在後6個月的追蹤期間，亦未有相似的症狀，且雙側內頸動脈瘤之大小也無變化。故第一線醫療人員對主訴為搏動性耳鳴的患者，鑑別診斷也需包括內側頸動脈瘤，又須與各別專科醫療團隊合作才能正確診斷及治療。給予個人化的治療，目的要改正潛在的危險因子如高血壓及減輕症狀。

Pulsatile tinnitus is a rare but serious symptom usually with a specific identifiable cause. Patients with pulsatile tinnitus are likely to have a serious underlying disease such as internal carotid artery aneurysm, which has remained a therapeutic challenge due to the absence of evidenced-based treatment guidelines. The study reports a rare case of hypertension with bilateral cervical internal carotid artery aneurysm initially presented as pulsatile tinnitus in left ear. Detailed review of clinical history, physical examination and radiologic evaluation helped establish a correct diagnosis of internal carotid artery aneurysm in this case. The patient experienced symptomatic relief after his blood pressure was lowered to below 130/80 mmHg with the combination of three different classes of antihypertensive drugs and the use of aspirin for stroke prevention. He no longer experienced pulsatile tinnitus and no interval change of internal carotid artery aneurysm was observed during the next six-month follow-up period. As illustrated by the reported case, awareness of internal carotid artery aneurysm as a cause of pulsatile tinnitus is important; moreover, diagnosis should be performed by a multidisciplinary team with a structured diagnostic pathway. Treatment of internal carotid artery aneurysm involves several clinical disciplines and should be directed towards the correction of individual underlying risk factors such as hypertension.