Taiwan J Fam Med Vol. 26 No.3 mmhg 160/100 mmhg 4 140/90 mmhg amlodipine 5mg, valsartan 80mg /85-90 mmhg 21 穏 174 cm 74 kg 91 cm 85 /

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1 [] ,5 (aspirin) 130/80 mmhg ; 26: DOI: / % [1,2] (subjective) (objective) (pulsatile tinnitus) [1-5] 4-10% [3,6] [3,4] [3,5] /

2 Taiwan J Fam Med Vol. 26 No.3 mmhg 160/100 mmhg 4 140/90 mmhg amlodipine 5mg, valsartan 80mg /85-90 mmhg 21 穏 174 cm 74 kg 91 cm 85 / 144/89 mmhg 141/93 mmhg (212 mg/dl) (complete blood count) (urinalysis) (99 mg/dl) (59 mg/dl) (127 mg/dl) (148 mg/dl) (pure tone audiometry, PTA) (tympanogram) (neurodiagnostic auditory brainstem response, NABR) 2.5 x 1.5 cm 1.7 x 1.0 cm x 1.5 cm 1.7 x 1.0 cm 130/80 mmhg (bisoprolol 5 mg aspirin (100 mg)

3 /75 mmhg 6 [7] [1,3,4] [3,4] [5] (fibromuscular dysplasia) (glomus tumors) (idiopathic intracranial hypertension) [1,3-5,7-9] 1 [9] 68% [9] 70% [10] [9] [1,2,4,5] [9,10] (1) (2) (3) (4) (5) (6) (7) (8) B12 [1,3,4] (1) (2) (3) (4) [1,3-5] PTA NABR [1-4] [1,3,4] [4]

4 Taiwan J Fam Med Vol. 26 No Paget s disease 5 Dtsch Arztebl Int 2013; 110: [3-8] % [11] % [12,13] 35.7% [13] mm mm [13,14] 2.5 cm [13] 1.5 cm Behçet s

5 / / 2 7 Clin Radiol 2009; 64: [11,13,15] [13,15] 20% [16] [11,12,15] [13] [13,15] [12-16] [12,17] [15,16]

6 Taiwan J Fam Med Vol. 26 No.3 25% 20% [17] 9% % [16,17] Li 92.8% 8.1% 1.8% 0.5%4.1% % 94.4% 6.3% [17] [12] [13,15] 50-71% [15] [13] [13,15] [12,13,15] 130/80 mmhg [18] 130/80 mmhg aspirin 100 mg 1. Crummer RW, Hassan GA: Diagnostic approach to tinnitus. Am Fam Physician 2004; 69: Lockwood AH, Salvi RJ, Burkard RF: Tinnitus. N Engl J Med 2002; 347: Liyanage SH, Singh A, Savundra P, Kalan A: Pulsatile tinnitus. J Laryngol Otol 2006; 120: Sismanis A: Pulsatile tinnitus: contemporary assessment and management. Curr Opin Otolaryngol Head Neck Surg 2011; 19: Hofmann E, Behr R, Neumann-Haefelin T, Schwager K: Pulsatile tinnitus: imaging and differential diagnosis. Dtsch Arztebl Int 2013; 110: Kircher ML, Standring RT, Leonetti JP: Neuroradiologic assessment of pulsatile tinnitus. Otolaryngol Head Neck Surg 2008; 139 (Suppl): Madani G, Connor SE: Imaging in pulsatile tinnitus. Clin Radiol 2009; 64:

7 Swartz JD: An approach to the evaluation of the patient with pulsatile tinnitus with emphasis on the anatomy and pathology of the jugular foramen. Semin Ultrasound CT MR 2004; 25: Sonmez G, Basekim CC, Ozturk E, Gungor A, Kizilkaya E: Imaging of pulsatile tinnitus: a review of 74 patients. Clinical Imaging 2007; 31: Marsot-Dupuch K: Pulsatile and nonpulsatile tinnitus: a systemic approach. Semin Ultrasound CT MR 2001; 22: Rana NR, Hodgson KJ, Ramsey D, Johnson CM: Management approach to an extracranial internal carotid artery aneurysm. J Vasc Surg 2013; 57: Welleweerd JC, Moll FL, de Borst GJ: Technical options for the treatment of extracranial carotid aneurysms. Expert Rev Cardiovasc Ther 2012; 10: Garg K, Rockman CB, Lee V, et al: Presentation and management of carotid artery aneurysms and pseudoaneurysms. J Vasc Surg 2012; 55: Noad RL, O Donnell ME, McCavert M, Gardner R, Lee B, Lau LL: A carotid artery aneurysm with a twist: case report and review. Ir J Med Sci 2012; 181: Dawson J, Fitridge R: Update on aneurysm disease: current insights and controversies: peripheral aneurysms: when to intervene is rupture really a danger? Prog Cardiovasc Dis 2013; 56: El-Sabrout R, Cooley DA: Extracranial carotid artery aneurysms: Texas Heart Institute experience. J Vasc Surg 2000; 31: Li Z, Chang G, Yao C, et al: Endovascular stenting of extracranial carotid artery aneurysm: a systematic review. Eur J Vasc Endovasc Surg 2011; 42: Chiang CE, Wang TD, Ueng KC, et al: 2015 guidelines of the Taiwan Society of Cardiology and the Taiwan Hypertension Society for the management of hypertension. J Chin Med Assoc 2015; 78: 1-47.

8 186 [Case Report] Cervical Internal Carotid Artery Aneurysm Presented as Pulsatile Tinnitus: A Case Report Jin-Hwa Chang 1, Yu-Hung Chen 2, Ming-Ju Wu 3 and Liang-Kuang Chen 4,5 Pulsatile tinnitus is a rare but serious symptom usually with a specific identifiable cause. Patients with pulsatile tinnitus are likely to have a serious underlying disease such as internal carotid artery aneurysm, which has remained a therapeutic challenge due to the absence of evidenced-based treatment guidelines. The study reports a rare case of hypertension with bilateral cervical internal carotid artery aneurysm initially presented as pulsatile tinnitus in left ear. Detailed review of clinical history, physical examination and radiologic evaluation helped establish a correct diagnosis of internal carotid artery aneurysm in this case. The patient experienced symptomatic relief after his blood pressure was lowered to below 130/80 mmhg with the combination of three different classes of antihypertensive drugs and the use of aspirin for stroke prevention. He no longer experienced pulsatile tinnitus and no interval change of internal carotid artery aneurysm was observed during the next six-month follow-up period. As illustrated by the reported case, awareness of internal carotid artery aneurysm as a cause of pulsatile tinnitus is important; moreover, diagnosis should be performed by a multidisciplinary team with a structured diagnostic pathway. Treatment of internal carotid artery aneurysm involves several clinical disciplines and should be directed towards the correction of individual underlying risk factors such as hypertension. (Taiwan J Fam Med 2016; 26: ) DOI: / Key words: aneurysm, hypertension, internal carotid artery, pulsatile tinnitus 1 Hsing Hua Clinic, New Taipei; 2 Department of Family Medicine, 4 Diagnostic Radiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei; 3 Department of Otolaryngology, National Taiwan University Hospital, Bei-Hu Branch, Taipei; 5 School of Medicine, Fu Jen Catholic University, Taipei, Taiwan. Received: November 12, 2015; Revised: December 21, 2015; Accepted: January 4, 2016.

( s y s t e m ) ( s t r e s s ) (stress model) ( s y s t e m ) [ ] [ 5 ] C o x [ 3 ] 1 [ 1, 2 ] [ 6-8 ] [ 9 ] Tw Fam Med Res 2003 Vol.1 No.1 23

( s y s t e m ) ( s t r e s s ) (stress model) ( s y s t e m ) [ ] [ 5 ] C o x [ 3 ] 1 [ 1, 2 ] [ 6-8 ] [ 9 ] Tw Fam Med Res 2003 Vol.1 No.1 23 1, 4 1, 2 3 1 4 1, 2 1977 E n g e l 1999 5 1 ( 1 ) ( 2 ) ( 3 ) ( 4 ) ( 5 ) 2003 1 2 2-32 stress model, stress analysis [ 1 ] ( p s y c h o g e n e s i s ) (holism) (biomedical model) ( r e d u c t i o