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CC BY-NC-ND 4.0 · Indian Journal of Neurosurgery 2024; 13(02): 181-182
DOI: 10.1055/s-0042-1758661
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Dural Arteriovenous Fistula with Hypoglossal Nerve Paralysis

Neha Thakur
1   Department of Otolaryngology-Head and Neck Surgery (ENT), Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
,
Sarita Negi
1   Department of Otolaryngology-Head and Neck Surgery (ENT), Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
,
Jagdeep S. Thakur 
1   Department of Otolaryngology-Head and Neck Surgery (ENT), Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
,
Suresh Thakur
2   Department of Neuroradiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
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A male in his early 30s presented with a swelling just below the angle of his left mandible for the last 2 months. The swelling had insidious onset, progressive and painless. Examination found 4 × 4cm, diffuse, soft to firm, pulsatile swelling in the upper part of the neck on left side ([Fig. 1]). An oral examination revealed left hypoglossal nerve paralysis. Further examination was noncontributory, including vagus and accessory spinal nerve examination. A probable diagnosis of carotid body tumor was kept, and the patient was subjected to computerized angiography. Angiography revealed dural arteriovenous fistula (DAVF), a rare clinical entity leading to hypoglossal nerve paralysis ([Figs. 2 (A, B)]). Patient was advised to undergo digital subtraction angiography for further management, but he refused and chose conservative care with regular follow-up.

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Fig. 1 A diffuse swelling in the neck (white arrow) with left hypoglossal nerve paralysis (black arrow).
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Fig. 2 (A, B) Computed tomography angiography showing arteriovenous malformation in the neck and its extension into the cranial cavity with dural arteriovenous fistula (white arrows).

Hypoglossal nerve paralysis due to DAVF is rare.[1] Digital subtraction angiography is the gold standard investigation, whereas endovascular embolization is the treatment of choice.[2] Regular follow-up with imaging is the option in a few selective cases.[2] [3] [4]



Publication History

Article published online:
13 January 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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