Dorothea Altschul MD FAHA FSVIN

“I woke up and the noise was gone.” My patient suffered from pulsatile tinnitus — that relentless whooshing sound in sync with her heartbeat. We found the cause. We treated it. Now: silence. Pulsatile tinnitus is real. And yes—it’s treatable. #PulsatileTinnitus #BrainFlow

The blood–brain barrier can be damaged and leaky decades after an athlete retires from contact sport. This leakiness seems to trigger a lasting immune response that is closely tied to cognitive decline go.nature.com/480ufQ7

She was told her brain MRA scan was ‘normal.’ But no one looked closely enough. That’s why I always want to see brain vessel imaging with my own eyes, and sometimes I am just not happy. The difference? Image quality. #IIH #pulsatiletinnitus

Spinal CSF-venous fistulas almost always arise from meningeal diverticula. The diverticular size can vary from tiny (submillimeter) to massive (think dural ectasia). At least one-third of diverticula change size when a fistula forms ⁦@spinalCSFleak⁩ pubmed.ncbi.nlm.nih.gov/41730631/

Brain pressure measurement may be entering a new era. For decades, measuring intracranial pressure meant placing a monitor through the skull. Last week I presented a new method measuring brain pressure through a vein in the arm. #IIH #pulsatiletinnitus

Jasper Johns’ chaos and crooked lines… then an alphabet. The brain is the same: hidden disorder beneath the surface, relief comes when we finally recognize the pattern.

@Gagosian , I stood before Jasper Johns and saw the brain. From afar: order. Up close: splashes, crooked lines, loud chaos. Then a pattern appears — and everything settles. Relief isn’t random. It’s recognition.

The middle meningeal artery (MMA) is densely innervated by trigeminal afferents. Targeting the MMA may reduce central sensitization and interrupt the pain cycle. Mechanism matters. 🧠 #HeadacheResearch #Migraine #pulsatiletinnitus #IIH

Skull “drain” veins pulse & ruffle to move fluid and let immune cells patrol. Brain borders are active—not passive. #IIH #pseudotumor #migraine #pulsatiletinnitus

If you suspect venous #pulsatiletinnitus, a standard MRI isn’t enough. You need an MRV with gadolinium—see for yourself. #IIH #pseudotumor

Eagle syndrome is a rare disorder probably made rarer by misdiagnosis. Dynamic venous pressure monitoring clearly demonstrates the underlying pathology and it is very amenable to a simple surgical solution. @ashamkhanmd @gustavomcortez #neurosurgery #neurosurgeon @cvsection

Endovascular shunt feasibility in shunt responsive idiopathic intracranial hypertension: morphometric radiographic analysis jnis.bmj.com/content/early/…

I know how hard it is to describe the tinnitus. Sometimes words fail — so match the sound instead 👂🫀 Use this pulsatile tinnitus simulator to find the rhythm closest to what you hear: 👉 checkhearing.org/pulsatiletinni…

If your scan was “borderline,” If a lumbar puncture helped—then symptoms returned, If weight changes affect your head, ears, or vision… #IIH isn’t just a narrow vein. It’s a congested venous system driven by pressure. 🧠

When I was in training, #pulsatiletinnitus was something patients were told to live with. #IIH was defined only by #papilledema. Today, I’m a co-author on a paper on IIH and cerebral venous outflow disorders, pointing to an optimistic future for patients once dismissed.

Hear a whooshing sound that matches your heartbeat in one ear? That’s vascular pulsatile tinnitus—not typical ringing or hissing. It often changes with position and is a blood-flow signal, not a hearing problem. #PulsatileTinnitus #HeartbeatInEar #VascularTinnitus #BrainHealth

We are starting 2026 with our IIH Series on January 14th, at 4pm EST. Dr. Mohamed Abdalkader, MD will be discussing venous diverticulum and pulsatile tinnitus. IIH_hub.com/series #iih #iihawareness #pulsatiletinnitus #venoussinusstenosis

Pulsatile tinnitus = audible blood flow. Normal imaging ≠ normal flow. Pressure leaves evidence. Bone keeps the score. #pulsatiletinnitus #IIH

Most people never realize how much precision it takes to touch the brain safely. This is where calm matters. This is where presence matters. Precision is presence. #DynamicBrainHealth

You don’t need to open the skull to reach the brain. We travel through the blood vessels. From the arm → to the brain in under 5 minutes. This is neurointervention. And yes… it’s real. 🧠✨ #NeuroIntervention #pulsatiletinnitus #IIH

Think jugular stenosis only happens at 90° head rotation? 🧠 📚 Multi-institutional study finds that fractional head turns can trigger severe IJV narrowing and significant pressure gradients. 📚 bit.ly/4pxKSt7 #NeuroIntervention #VenousDisease #CerebralVenous #Imaging