Pulsatile tinnitus due to intracranial arteriovenous fistula indirectly identified by carotid Doppler ultrasound

Abstract Pulsatile tinnitus is a specific type of sound caused by vascular anomalies, usually associated with turbulent blood flow, secondary to high-output stenosis or arterial tortuosity. These alterations can produce rhythmic sounds that compromise patients’ quality of life. This report describes the case of a 51-year-old woman with pulsating tinnitus in her right ear for 18 months. No significant changes were identified on arterial computed tomography angiography or cranial magnetic resonance angiography due to the non-completion of the joint venous phase. Carotid Doppler ultrasound showed abnormal flow in the right external carotid artery, with a decreased resistance index, suggesting an arteriovenous fistula. Cerebral angiography confirmed the diagnosis, showing communication between external carotid artery branches and intracranial veins. The patient underwent endovascular treatment with embolization, resulting in complete resolution of symptoms and normalization of Doppler parameters at 24-month follow-up.