Abstract
Introduction The hypoglossal canal is an uncommon location for a dural arteriovenous fistula (AVF). Case reports suggest tinnitus is a common symptom in people with hypoglossal canal dural AVF whilst hypoglossal nerve palsy has been rarely reported in this setting. We report a patient with intermittent tongue paresis in the setting of a hypoglossal canal dural AVF.
Case A 70-year-old female presented with a three week history of daily, recurrent, 5 minute episodes of difficulty speaking and difficulty controlling her tongue. She described tongue deviation to the left on protrusion and difficulty moving it to the right. She had presented to the local emergency department on two occasions with these symptoms with negative stroke protocol scans.
She has a history of hypercholesterolaemia and a recent finding of a left hypoglossal canal dural arteriovenous fistula (AVF) which was identified on magnetic resonance imaging (MRI) of the brain to investigate 6 months of left sided tinnitus which had since resolved.
MRI brain, angiogram and venogram again showed a left hypoglossal canal dural AVF with no other acute findings, and EEG was unremarkable. A catheter cerebral angiogram confirmed a left base of skull fistula, without corticovenous reflux. She was diagnosed with intermittent tongue paresis due to left hypoglossal canal dural AVF. She remains under surveillance and has not had recurrence of her symptoms.
Conclusion New onset tinnitus and/or tongue paresis should be investigated, and although uncommon, dural arteriovenous fistula should be considered with vascular imaging forming part of the investigation.
