Heavily T2- weighted thin-section sequences of MRI head can detect the neurovascular loops in patients with PT [61,62]. Typewriter tinnitus is described as paroxysmal attacks of staccato sounds, thought to be caused by neurovascular compression of the cochlear nerve, and responds well to carbamazepine. MRI without IV contrast can also detect some larger mass lesions like glomus jugulare and AVM that can cause PT. However, absence of contrast would limit its ability to detect smaller masses and AVM. MRV Head With IV Contrast MRV head with IV contrast is a robust tool for detecting stenosis in the transverse sinuses, which could lead to tinnitus in association with IIH. Dural venous sinus stenosis could be from an intrinsic or extrinsic cause [66,67]. The source images can potentially detect a prominent sigmoid sinus diverticulum. However, MRV does not provide bony details to evaluate other pathologies that can cause PT such as sigmoid wall dehiscence and jugular foramen dehiscence. MRV Head Without and With IV Contrast MRV head with IV contrast is a robust tool to detect stenosis in the transverse sinuses, which could lead to tinnitus in association with IIH as described in the previous section. However, MRV does not provide bony details to evaluate other pathologies that can cause PT such as sigmoid wall dehiscence and jugular foramen dehiscence. There is no added benefit in simultaneously performing MRV head without IV contrast also. MRV Head Without IV Contrast MRV head without IV contrast can detect transverse sinus stenosis, but flow-related artifacts can limit optimal evaluation of the transverse sinus stenosis and sigmoid sinus diverticulum [56]. Arachnoid granulations can mimic transverse sinus stenosis. US Duplex Doppler Carotid Artery US duplex Doppler carotid artery is useful to detect atherosclerotic narrowing of the carotids, which is a cause of PT. Atherosclerosis can lead to arterial stiffness, which is also associated with tinnitus [68].
Tinnitus. Heavily T2- weighted thin-section sequences of MRI head can detect the neurovascular loops in patients with PT [61,62]. Typewriter tinnitus is described as paroxysmal attacks of staccato sounds, thought to be caused by neurovascular compression of the cochlear nerve, and responds well to carbamazepine. MRI without IV contrast can also detect some larger mass lesions like glomus jugulare and AVM that can cause PT. However, absence of contrast would limit its ability to detect smaller masses and AVM. MRV Head With IV Contrast MRV head with IV contrast is a robust tool for detecting stenosis in the transverse sinuses, which could lead to tinnitus in association with IIH. Dural venous sinus stenosis could be from an intrinsic or extrinsic cause [66,67]. The source images can potentially detect a prominent sigmoid sinus diverticulum. However, MRV does not provide bony details to evaluate other pathologies that can cause PT such as sigmoid wall dehiscence and jugular foramen dehiscence. MRV Head Without and With IV Contrast MRV head with IV contrast is a robust tool to detect stenosis in the transverse sinuses, which could lead to tinnitus in association with IIH as described in the previous section. However, MRV does not provide bony details to evaluate other pathologies that can cause PT such as sigmoid wall dehiscence and jugular foramen dehiscence. There is no added benefit in simultaneously performing MRV head without IV contrast also. MRV Head Without IV Contrast MRV head without IV contrast can detect transverse sinus stenosis, but flow-related artifacts can limit optimal evaluation of the transverse sinus stenosis and sigmoid sinus diverticulum [56]. Arachnoid granulations can mimic transverse sinus stenosis. US Duplex Doppler Carotid Artery US duplex Doppler carotid artery is useful to detect atherosclerotic narrowing of the carotids, which is a cause of PT. Atherosclerosis can lead to arterial stiffness, which is also associated with tinnitus [68].