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]
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