Cerebral Vasospasm in Raynaud’s Syndrome Manifesting as Pulsatile Tinnitus

Abstract

Background: Pulsatile tinnitus is a pulse synchronous audible whooshing sensation that arises from turbulent flow in stenotic intracranial or upper cervical arteries, amidst other pathologies, yet is often idiopathic in origin. Raynaud’s syndrome involves peripheral vasoconstriction, but possibly also cerebral vasoconstriction. The presence of cerebral vasoconstriction in Raynaud’s was evaluated by ascertaining the prevalence of pulsatile tinnitus compared to a control population.
Methods: Pulsatile tinnitus was defined in this study as pulse synchronous audible sensations that were both bothersome and manifested during routine
activities. Its presence was ascertained in consecutive patients with Raynaud’s syndrome and compared to a consecutive control population who met the same inclusion criteria. The study consisted of 6 patients with Raynaud’s and 58 control patients. Analysis was performed using Fisher’s exact test.
Findings: Four of Six (4/6) patients with Raynaud’s had bothersome pulsatile tinnitus compared to Zero of 58 patients without Raynaud’s, with a significance level of p<0•0002. There was no correlation between pulsatile tinnitus and common vascular risk factors including hypertension (p<0•9999), hyperlipidemia (p<0•9999), diabetes mellitus (p<0•9999), coronary artery disease (p<0•9999), cerebral vascular disease (p<0•9999), as well as vasculitis
(p<0•4632) or conductive hearing loss (p<0•9999).
Interpretation: Pulsatile tinnitus due to cerebral vasoconstriction appears to be a common manifestation of Raynaud’s. Diagnostic evaluation of pulsatile tinnitus may also warrant an evaluation for Raynaud’s syndrome.