Anterior Communicating Artery Aneurysm Presenting as Pulsatile Tinnitus

Objective tinnitus is caused by a vascular abnormality of the cervical region, skull base or intracranium. These lesions produce an abnormal flow lesion in the arterial or venus circulatory system of the brain, skull base or cervical region. This flow abnormality is perceived by the auditory system as pulsatile tinnitus. An aberrant carotid artery, a dehiscent jugular bulb or a glomus tumor are common causes. The cause of subjective tinnitus is often not found. Many serious vascular anomalies and tumors can present as pulsatile tinnitus. These include: arteriovenous malformations, atherosclerotic vascular disease, and intracranial tumors with elevated cerebrospinal fluid pressure. We recently diagnosed a patient with an anterior communicating artery aneurysm presenting with pulsatile tinnitus. An aneurysm presenting as pulsatile tinnitus is extremely uncommon. Only 8 have been identified in the literature. The clinician evaluating patients with tinnitus must be aware of this diagnosis. A complete evaluation should include an appropriate radiologic exam; either computed tomography or magnetic reasonance imaging.