Tinnitus is a discomforting condition associated with a sound in one or both ears that occurs without an external stimulus and can be either pulsatile or continuous. Vascular and non-vascular factors involve in etiology of pulsatile tinnitus (PT) that requires a careful physical examination and evaluation with proper and sophisticated imaging techniques to identify the cause(s). In clinical experience, it is known that turning neck towards affected ear decreases PT, whereas turning neck towards unaffected side increases PT in venous hum, due to bending of internal jugular vein (IJV) over the transverse process of the atlas which leads to increased blood flow. In this report, we presented a rare PT case caused directly by jugular vein stenosis, in which clinical characteristics were in disagreement with the literature. In our case, PT markedly reduced, instead of being aggravated, when turning neck to unaffected side in a 35-year old woman. Moreover, there were axial maximal intensity above the left jugular bulb and about 85% stenosis in 3-D volume rendering images. We also discussed the differential diagnosis by multidetector computed tomography angiography with respect to its advantageous over other imagining techniques such as CT, MRI, and MRA as well as conventional angiography.
Manuscripts that are Published Ahead of Print have been peer reviewed and accepted for publication by the Editorial Board of the West Indian Medical Journal. They may appear in their original format and may not be copy edited or formatted in the style guide of this Journal. While accepted manuscripts are not yet assigned a volume, issue or page numbers, they can be cited using the DOI and date of e-publication. See our Instructions for Authors on how to properly cite manuscripts at this stage. The contents of the manuscript may change before it is published in its final form. Manuscripts in this section will be removed once they have been issued to a volume and issue, but will still retain the DOI and date of e-publication.