Sagittal sinus dural arteriovenous fistula manifesting as unilateral vocal fold paresis

We present a case of a sagittal sinus dural arteriovenous fistula manifesting as dysphonia secondary to vocal fold paresis. The patient presented with a 6-week history of hoarseness. Imaging studies demonstrated findings suggestive of a dural arteriovenous fistula affecting the superior sagittal sinus. Direct laryngoscopy demonstrated paresis of the right vocal fold. We hypothesized that pressure on the vagus nerve from a dilated and arterialized internal jugular vein within the jugular foramen was responsible for the cranial neuropathy. The patient's dysphonia resolved with embolization of the fistula, and repeat laryngoscopy showed resolution of the vocal fold paresis.