Suicidal Ideation in a Severe Case of NonPulsatile Tinnitus Caused by a Dural Arteriovenous Fistula

Pulsatile tinnitus is often the initial presentation of a dural arteriovenous fistual, so a high index of suspicion is needed to avoid misdiagnoses and possible fatal consequences. Although pulsatile tinnitus commonly originates from a vascular malformation and non-pulsatile tinnitus from a neurodegenerative one, pulsatile and non-pulsatile presentations can result from other underlying pathologies. If a vascular pathology causes a non-pulsatile complaint that cannot be heard by the examiner or detected clinically or radiologically, it is bound to be misdiagnosed as central tinnitus.