Clinical question: 40F with left pulsatile tinnitus and SNHL and nasal congestion with decreased smellSigns and Symptoms: above MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. There is extracranial origin of the left posterior inferior cerebellar artery present.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.IACNo abnormal foci of enhancement are appreciated within the internal auditory canals. The cochlea and semicircular canals appear intact. The cochlear nerve can be followed bilaterally tracking into the cochlea. The modiolus is well formed bilaterally.No abnormal enhancing lesions are appreciated at the cerebellopontine angle cisterns nor the internal auditory canals.
1.There is no evidence for an internal auditory canal mass or other lesion to account for the patient's suspected sensorineural hearing loss.2.There is no evidence for intracranial aneurysm to account for the patient's sensorineural hearing loss.3.There is no convincing evidence for arteriovenous fistula on the basis of this exam to account for pulsatile tinnitus. However, conventional angiography is more sensitive in detecting arteriovenous fistula than MR angiography.