Dural Arteriovenous Fistula with Hypoglossal Nerve Paralysis

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.

Fig. 1 A diffuse swelling in the neck (white arrow) with left hypoglossal nerve paralysis (black arrow).

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]

Conflict of Interest

None declared.

• References

• 1 Chan NHHL. Hypoglossal dural arteriovenous fistula: a rare cause of unilateral hypoglossal nerve palsy. BJR Case Rep 2017; 3 (03) 20160144
• 2 Mayercik VA, Sussman ES, Pulli B. et al. Efficacy and safety of embolization of dural arteriovenous fistulas via the ophthalmic artery. Interv Neuroradiol 2021; 27 (03) 444-450
• 3 Baharvahdat H, Ooi YC, Kim WJ, Mowla A, Coon AL, Colby GP. Updates in the management of cranial dural arteriovenous fistula. Stroke Vasc Neurol 2019; 5 (01) 50-58
• 4 Hiramatsu M, Sugiu K, Hishikawa T. et al. Results of 1940 embolizations for dural arteriovenous fistulas: Japanese Registry of Neuroendovascular Therapy (JR-NET3). J Neurosurg 2019; 133 (01) 166-173

Publikationsverlauf

Artikel online veröffentlicht:
13. Januar 2023