{
  "abstract": "Background This study investigates a rare cause of pulsatile tinnitus related to a dehiscent duplication of the jugular bulb associated with a non-stenotic dominant oblique occipital sinus. We report a series of treated patients and describe a novel radiological feature—the ‘playing card heart sign’.Methods In this retrospective single-center study, four patients presenting with venous pulsatile tinnitus due to five dehiscent jugular bulb duplications associated with a non-stenotic dominant oblique occipital sinus were included between January 2023 and September 2024. Clinical assessment included symptom onset, body mass index, and Tinnitus Handicap Inventory score. High-resolution temporal bone CT scans and cerebral venous imaging were used to identify anatomical anomalies. Patients with a significant clinical impact underwent endovascular stenting. Outcomes were assessed at follow-up.Results The mean patient age was 41.9 years, with a median body mass index of 27.4 kg/m². Tinnitus was unilateral in three patients and alternating in one. Imaging revealed a bony dehiscence overlying a duplicated jugular bulb, ipsilateral to a non-stenotic dominant oblique occipital sinus, with no venous pressure gradient. Stenting (n=5) led to complete resolution of tinnitus in all patients, with a median follow-up of 15 months and no reported complications.Conclusions Jugular bulb duplication with dehiscence, associated with a non-stenotic dominant oblique occipital sinus, represents an under-recognized cause of pulsatile tinnitus. This condition can be effectively treated with stenting. Identification of the ‘playing card heart sign’ on imaging is key for accurate diagnosis and management.",
  "authors": [
    {
      "affiliations": [
        "Faculté de Médecine, Université Paris Cité, Paris, France",
        "Department of Neuroradiology, Hôpital Lariboisière, AP-HP, Paris, France"
      ],
      "name": "Alexis Guédon"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Hôpital Lariboisière, AP-HP, Paris, France"
      ],
      "name": "Nawel Mohammed-Brahim"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Hôpital Lariboisière, AP-HP, Paris, France"
      ],
      "name": "Francesco Arpaia"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Hôpital Lariboisière, AP-HP, Paris, France"
      ],
      "name": "Matteo Fantoni"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Hôpital Lariboisière, AP-HP, Paris, France"
      ],
      "name": "Vittorio Civelli"
    },
    {
      "affiliations": [
        "Faculté de Médecine, Université Paris Cité, Paris, France",
        "Department of Neuroradiology, Hôpital Lariboisière, AP-HP, Paris, France"
      ],
      "name": "Emmanuel Houdart"
    }
  ],
  "title": "Non-stenotic dominant oblique occipital sinus causing dehiscent duplication of the jugular bulb: imaging diagnosis and novel endovascular management with stenting",
  "uid": "12b3975b-da75-5515-8e19-f55e9db735d6"
}