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.