MRI/MRA of Brain, Skull Base, and Neck — Can You Figure Out My Diagnosis?

[Russell Grimes]

I had my scans yesterday and they took over an hour. This is YOUR chance to read my signs and symptoms and see if you can arrive at the correct diagnosis before the radiologist and doctors. Good luck! I should have an answer (or not) in several days.

Symptoms:

Unilateral ringing pulsatile tinnitus that sounds like cymbals crashing. I can increase the sound by opening my jaw and decrease the sound when closing the jaw.

Pulsatile tinnitus that crescendos when changing positions and an accompanying increase in cardiac output. Sounds like blood rushing through a vessel.

Pulsatile tinnitus gets louder or at least becomes more prominent if I press on my temporal bone or neck.

Hissing sound when bending head forward or to the right.

Prominent clicking in my throat after swallowing. Click is objective and arises from somewhere above the Adam's Apple, not far below my chin. Clicking intensity changes depending upon head position.

Cervical spine burning soreness with activity and occasionally a sharp pain if I move a certain way.

Occasional, fleeting dull left ear pain that seems to be referred from the cervical spine.

After analyzing my symptoms for five months, I have arrived at my four most likely diagnoses. I firmly believe I will have an answer from the scans.

In my opinion, my most likely diagnosis is a glomus jugulare tumor. My second most likely diagnosis is an acoustic neuroma and my third most likely diagnosis is an arteriovenous fistula. My fourth most likely diagnosis is a vertebral bone spur applying pressure to my carotid artery and causing Eustachian tube dysfunction.

HOW ABOUT YOU? What are your thoughts? Use the foregoing information to arrive at your best hypothesis.

 

[Russell Grimes]

The only findings by the radiologist were incidental. He discovered a high riding right jugular bulb and a diminutive right vertebral artery.

I have had hissing when bending head forward and turning head to the right. High-pitched pulsatile tinnitus also worsens with movement and seems oftentimes to be movement dependent. I have also had some burning pain in my cervical spine. At this point, I think my problems are arising from a compressed vertebral artery or some other anomaly of the spine that must be investigated.

 

[Rafaa]

I cannot offer much but have your thyroid looked at for nodules or a goitre. I have pulsatile tinnitus like you, and the throat click. I have a goitre with normal thyroid labs. They discovered a carotid bruit but wouldn't tell me if that was the cause of my pulsatile tinnitus.

What's next for you? Spine MRI?

 

[Russell Grimes]

I cannot offer much but have your thyroid looked at for nodules or a goitre. I have pulsatile tinnitus like you, and the throat click. I have a goitre with normal thyroid labs. They discovered a carotid bruit but wouldn't tell me if that was the cause of my pulsatile tinnitus.

What's next for you? Spine MRI?

When I see the ENT on the 23rd of this month for a follow up, I will request an MRI of my cervical and thoracic spine. I am getting soreness of the cervical spine and neck that activity worsens and activity also worsens my pulsatile tinnitus. I think they are related.

I am not sure if the ENT checked my thyroid when I was there last time but I will ask him about the possibility. I have no carotid bruit and the MRA indicates I have no issue with my internal or external carotid arteries.

Your goiter is causing your pulsatile tinnitus? What is the treatment?

 

[Rafaa]

When I see the ENT on the 23rd of this month for a follow up, I will request an MRI of my cervical and thoracic spine. I am getting soreness of the cervical spine and neck that activity worsens and activity also worsens my pulsatile tinnitus. I think they are related.

I am not sure if the ENT checked my thyroid when I was there last time but I will ask him about the possibility. I have no carotid bruit and the MRA indicates I have no issue with my internal or external carotid arteries.

Your goiter is causing your pulsatile tinnitus? What is the treatment?

It's the only thing that can cause mine after various experts have ruled out anything else. The thing is, the only solution for me would be removal of the thyroid lobe without guarantee of cure. So I'm waiting for hearing medication for another 2 years. If there is nothing, I will take the chance and remove my right lobe. Then if no benefit from that, I will remove my middle ear muscles. They are extremely sensitive and I believe are tensing up when my pulse increases. The muscle activates even when scratching my head. The endocrinologist confirmed bruit. So the turbulent blood flow combined with the hearing damage which causes internal sounds louder has resulted in intermittent pulsatile tinnitus.

Best for you to ask an endocrinologist or get an ultrasound in case the MRA missed it.

 

[Russell Grimes]

In January 2022, I started getting predominantly right-sided, high-pitched pulsatile tinnitus and a prominent popping in my throat when swallowing. The pulsatile tinnitus varies in intensity and is worst when changing positions, such as standing from sitting and rolling over in bed. When I bounce, I hear a rhythmic sound in my ear and the pulsatile tinnitus intensifies with exercise.

In June of 2022, I had an MRI and MRA of brain, skull base and neck vessels, which showed nothing but an asymmetrically prominent jugular bulb.

A month ago I had a CT scan of my temporal bones which was completely unremarkable. Three weeks ago I had an MRI with and without contrast of my cervical spine which also showed nothing and three days ago I had an MRV of my brain, which showed nothing.

On May 26, I am scheduled to have a bilateral carotid and jugular vein ultrasound and then I will talk with a doctor at a heart institute. August 1 I am scheduled for a sleep study.

My testing options are dwindling. I am disheartened I have no answers. There must be a connection between the prominent clicking in my throat when swallowing and the pulsatile tinnitus but no doctor can find the problem.

 

[momus]

Let us know how that comes out. I was looking at your type of tinnitus online, and it mentioned that, along w/ needing to find the underlying cause, over 30% of the cases end up basically unidentified. You mentioned that there must be a connection between the prominent clicking in your throat when swallowing and the pulsatile tinnitus, but do you know that for a fact? It may or may not be related, unless tests show that is actually the issue.

You're doing all the right things by systematically having your imaging done, so the good news is they haven't uncovered anything serious. I know, it sounds funny saying that no news is sorta good news, but you seem to have eliminated some of the more serious causes.

Good luck w/ it, and stay focused on getting some answers. I know in my case, sometimes just a second opinion can be handy when things seem to stop moving forward.

 

[makeyourownluck]

He discovered a high riding right jugular bulb

Is this not a cause of pulsatile tinnitus?

Abstract Number ‐ 119: Stent‐Coil Embolization Of A High Riding Jugular Bulb For Symptomatic Pulsatile Tinnitus

 

[Russell Grimes]

Is this not a cause of pulsatile tinnitus?

Yes, based upon my research, it is possible. Unless they missed a DAVF, it may be the cause of my problems. I am sitting right now and it feels like my right ear is clogged a little. There is an echoic sound of I tap behind my ear and it feels a little full. It gets better and worse throughout the day. It feels like it could be some kind of venous congestion or something. At the same time my problems started I also starts getting a prominent click in my thrust every time I swallow, leading me to believe there is some kind of vascular compression.

I am extremely agitated. I can't believe nobody came find the source of my problems. I will see what the heart institute people say when I go on Friday for my bilateral carotid ultrasound.

Abstract Number ‐ 119: Stent‐Coil Embolization Of A High Riding Jugular Bulb For Symptomatic Pulsatile Tinnitus[/QUOTE]

 

[makeyourownluck]

@Russell Grimes, I have constant pressure behind my right ear too, sometimes it flares up for weeks/months - no rhyme or reason to it, so I stopped bothering trying to prevent it. I think it's the worst symptoms ear-wise, that or distortions. I've toyed with the idea of a vein pressing on something, but I go between that and thinking I've got an air bubble in my inner ear or something. I don't know, it's all guesswork at this point as I don't fancy the MRI. That pressure though, if I could get rid of that, I'd be so happy.

Hopefully your high riding bulb is the cause and it can be resolved I understand how you're feeling though, it's tough dealing with otherwise invisible conditions.

 

[Russell Grimes]

@Russell Grimes, I have constant pressure behind my right ear too, sometimes it flares up for weeks/months - no rhyme or reason to it, so I stopped bothering trying to prevent it. I think it's the worst symptoms ear-wise, that or distortions. I've toyed with the idea of a vein pressing on something, but I go between that and thinking I've got an air bubble in my inner ear or something. I don't know, it's all guesswork at this point as I don't fancy the MRI. That pressure though, if I could get rid of that, I'd be so happy.

Hopefully your high riding bulb is the cause and it can be resolved I understand how you're feeling though, it's tough dealing with otherwise invisible conditions.

The MRI isn't bad. I have had three, all with contrast. Just close your eyes and try to focus on the music that you need to focus to hear because the machine gets so loud. It is likely the MRI will show nothing but a test with no news is good news because it helps eliminate possible problems and brings one closer to a potential diagnosis. It is just a process of elimination.