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Robinson C, Maraj D, Minhas JS, Bhatia M, Kak V. Gradenigo's Syndrome and Vernet Syndrome as Presenting Signs of Nasopharyngeal Carcinoma. Cureus 2023; 15:e41636. [PMID: 37565094 PMCID: PMC10411312 DOI: 10.7759/cureus.41636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 08/12/2023] Open
Abstract
Both Gradenigo's syndrome and Vernet syndrome are rare pathologies of the intracranial space; both involve compression of a particular anatomic location in the skull, thus affecting structures nearby or within that space. A patient presenting with one or both of these syndromes should raise concern for malignancy, head trauma, or an intracranial infection. We present a case of a 39-year-old female with three weeks of left-sided ear, face, and neck pain along with difficulty swallowing and reduced vision in the left eye. Magnetic resonance imaging of the brain revealed fullness in the left nasopharyngeal region, raising concern for malignancy or infection. Biopsy of the mass ultimately revealed Epstein-Barr virus positive nasopharyngeal carcinoma, nonkeratinizing undifferentiated type, along with culture data revealing methicillin-resistant Staphylococcus aureus positive left otomastoiditis. She received chemoradiation therapy along with six weeks of antibiotic therapy. A patient presenting with symptoms reflective of a sinus infection unrelieved by antibiotics with concomitant cranial nerve deficits should raise clinical concern for an intracranial pathology rather than a simple case of sinusitis.
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Affiliation(s)
- Ciji Robinson
- Internal Medicine, Henry Ford Health System, Jackson, USA
| | - Diva Maraj
- Internal Medicine, Henry Ford Health System, Jackson, USA
| | - Jasdeep S Minhas
- Medicine, St. George's University School of Medicine, St. George's, GRD
| | | | - Vivek Kak
- Infectious Disease, Henry Ford Health System, Jackson, USA
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Adjepong KO, LaHue SC, Ha D, Holmes BB. Jugular Foramen Syndrome Caused by Varicella Zoster Virus Infection. Neurohospitalist 2023; 13:290-293. [PMID: 37441204 PMCID: PMC10334059 DOI: 10.1177/19418744221116717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
Jugular foramen syndrome (JFS) is a lower cranial neuropathy syndrome characterized by dysphonia and dysphagia. The syndrome is caused by dysfunction of the glossopharyngeal, vagus, and spinal accessory nerves at the level of the pars nervosa and pars vascularis within the jugular foramen. There are numerous etiologies for JFS, including malignancy, trauma, vascular, and infection. Here, we present the case of a healthy adult man who developed JFS secondary to an atypical presentation of Varicella Zoster meningitis, and was promptly diagnosed and treated with rapid symptom resolution. We diagnosed the patient using specialized skull-based imaging which detailed the jugular foramen, as well as CSF analysis. This case highlights the clinical value of detailed structural evaluation, consideration for infection in the absence of systemic symptoms, and favorable outcomes following early identification and treatment.
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Affiliation(s)
- Kwame O. Adjepong
- Department of Neurology, School of Medicine, University of California, San Francisco, CA, USA
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Sara C. LaHue
- Department of Neurology, School of Medicine, University of California, San Francisco, CA, USA
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Deborah Ha
- Rehabilitative Services, University of California San Francisco, San Francisco, CA, USA
| | - Brandon B. Holmes
- Department of Neurology, School of Medicine, University of California, San Francisco, CA, USA
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
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Braut T, Maršić M, Ravlić I, Maržić D, Marijić B, Malvić G, Vrebac I, Velepič M. Posttraumatic Vernet syndrome without fracture: A case report and short literature review. Medicine (Baltimore) 2021; 100:e27618. [PMID: 34713846 PMCID: PMC8556020 DOI: 10.1097/md.0000000000027618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/13/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE The aim of this case is to emphasize the need to include nerve traction in the differential diagnosis of nerve deficits associated with Vernet syndrome. This mechanism of injury has been described only once, but must not be overlooked and should be considered and included as a possible cause in diagnostic algorithms. PATIENT CONCERNS A patient presenting with dysphagia, extreme hoarseness, and limited shoulder movement after head injury was admitted to the emergency department. DIAGNOSES Multidisciplinary evaluation was performed, and nerve traction-induced Vernet syndrome was established as a running diagnosis. INTERVENTIONS Intensive swallowing and speech exercises, assisted by a specialist, were performed. OUTCOMES Swallowing and speech exercises significantly and objectively improved the patient's swallowing and voice, with mild hoarseness of voice remaining as the main symptom. Spectral acoustic analysis went from a voice pitch of 163.77 Hz to normal (187.77 Hz), jitter improved from 17.87% to 0.86% and shimmer values decreased from 39.86% to 19.60%. Breathiness during phonation measuring 2.91% was reduced to 1.08% and appropriate average intensity of voice (63.95 dB) was achieved. Initial dysphagia and fluid retention in the right piriform sinus, along with tracheal aspiration, were not observed in control fiberoptic endoscopic evaluation of swallowing. LESSONS According to our knowledge and literature data, this is the second reported case of posttraumatic Vernet syndrome without radiologically confirmed jugular foramen fracture, induced by nerve traction. Such patients need a prompt multidisciplinary approach in diagnosis and timely posttraumatic rehabilitation therapy for favorable clinical evolution and retrieval of nerve function.
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Affiliation(s)
- Tamara Braut
- Clinic of Otorhinolaryngology and Head and Neck Surgery, Rijeka University Hospital Center, Rijeka, Croatia
| | - Matej Maršić
- Clinic of Otorhinolaryngology and Head and Neck Surgery, Rijeka University Hospital Center, Rijeka, Croatia
| | - Iva Ravlić
- University of Rijeka, Faculty of Medicine, Rijeka, Croatia
| | - Diana Maržić
- Clinic of Otorhinolaryngology and Head and Neck Surgery, Rijeka University Hospital Center, Rijeka, Croatia
| | - Blažen Marijić
- Clinic of Otorhinolaryngology and Head and Neck Surgery, Rijeka University Hospital Center, Rijeka, Croatia
| | - Goran Malvić
- Clinic of Otorhinolaryngology and Head and Neck Surgery, Rijeka University Hospital Center, Rijeka, Croatia
| | - Ilinko Vrebac
- Clinic of Otorhinolaryngology and Head and Neck Surgery, Rijeka University Hospital Center, Rijeka, Croatia
| | - Marko Velepič
- Clinic of Otorhinolaryngology and Head and Neck Surgery, Rijeka University Hospital Center, Rijeka, Croatia
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Wolcott Z, Goldstein ED. A man with tongue pain: A case study. Headache 2021; 61:1295-1298. [PMID: 34510447 DOI: 10.1111/head.14183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/18/2021] [Accepted: 05/25/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Zoe Wolcott
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Eric D Goldstein
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
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Fan JN, Fan J, Ali H. Cranial nerve involvement in varicella zoster virus after renal transplantation. Proc (Bayl Univ Med Cent) 2020; 33:612-613. [DOI: 10.1080/08998280.2020.1775031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Jennifer Nielsen Fan
- Department of Family Medicine, Baylor Scott & White Medical Center – Round Rock, Round Rock, Texas
| | - Jerry Fan
- Department of Internal Medicine, Baylor Scott & White Medical Center – Temple, Temple, Texas
| | - Hameed Ali
- Department of Internal Medicine, Baylor Scott & White Medical Center – Temple, Temple, Texas
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Lower cranial nerve syndromes: a review. Neurosurg Rev 2020; 44:1345-1355. [PMID: 32638140 DOI: 10.1007/s10143-020-01344-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 06/09/2020] [Accepted: 06/26/2020] [Indexed: 10/23/2022]
Abstract
The purpose of this paper is to provide a comprehensive review encompassing the syndromes associated with the lower cranial nerves (LCNs). We will discuss the anatomy of some of these syndromes and the historical contributors after whom they were named. The LCNs can be affected individually or in combination, since the cranial nerves at this level share their courses through the jugular foramen and hypoglossal canal and the extracranial spaces. Numerous alterations affecting them have been described in the literature, but much remains to be discovered on this topic. This paper will highlight some of the subtle differences among these syndromes. Symptoms and signs that have localization value for LCN lesions include impaired speech, deglutition, sensory functions, alterations in taste, autonomic dysfunction, neuralgic pain, dysphagia, head or neck pain, cardiac or gastrointestinal compromise, and weakness of the tongue, trapezius, or sternocleidomastoid muscles. To assess the manifestations of LCN lesions correctly, precise knowledge of the anatomy and physiology of the area is required. Treatments currently used for these conditions will also be addressed here. Effective treatments are available in several such cases, but a precondition for complete recovery is a correct and swift diagnosis.
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Ferreira J, Franco A, Teodoro T, Coelho M, Albuquerque L. Vernet syndrome resulting from varicella zoster virus infection—a very rare clinical presentation of a common viral infection. J Neurovirol 2018. [DOI: 10.1007/s13365-018-0622-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
The posterior skull base can be involved by a variety of pathologic processes. They can be broadly classified as: traumatic, neoplastic, vascular, and inflammatory. Pathology in the posterior skull base usually involves the lower cranial nerves, either as a source of pathology or a secondary source of symptoms. This review will categorize pathology arising in the posterior skull base and describe how it affects the skull base itself and surrounding structures.
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Affiliation(s)
- Joici Job
- Department of Radiology, University of Pittsburgh Medical Center, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Barton F Branstetter
- Department of Radiology, University of Pittsburgh Medical Center, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
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Park H. Diverse clinical manifestations caused by varicella-zoster virus reactivation. Yeungnam Univ J Med 2016. [DOI: 10.12701/yujm.2016.33.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Hosun Park
- Department of Microbiology, College of Medicine, Yeungnam University, Daegu, Korea
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Taniguchi D, Nakahara Ph D T, Nakajima S, Nakazato T, Mikasa M, Furukawa Ph D Y. [Successful treatment with acyclovir and a corticosteroid for lower cranial polyneuropathy in zoster sine herpete: a case report]. Rinsho Shinkeigaku 2015; 55:932-5. [PMID: 26511031 DOI: 10.5692/clinicalneurol.cn-000781] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 62-year-old woman developed meningitis as well as acute paralysis of glossopharyngeal, vagus, and accessory nerves on the right side and also had dysfunction of the left hypoglossal nerve. Although there was no evidence of a typical cutaneous or mucosal herpetic lesion, PCR detection of varicella zoster virus (VZV)-DNA in cerebrospinal fluid confirmed the clinical diagnosis of polyneuritis cranialis due to VZV infection and zoster sine herpete. After starting intravenous acyclovir and methylprednisolone, her hypoglossal nerve palsy disappeared within a day and all other symptoms and signs dramatically improved. A rapid improvement observed in our patient suggests that the right cranial polyneuropathy could be caused by inflammation associated with epineurial edema (where the ninth, tenth, and eleventh cranial nerves pass through the right jugular foramen), whereas the exact mechanism of the twelfth cranial nerve involvement on the contralateral side is unknown. Our clinical findings indicate that acute lower cranial polyneuropathy in patients with zoster sine herpete should be treated immediately with combined administration of acyclovir and an anti-inflammatory corticosteroid.
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Affiliation(s)
- Daisuke Taniguchi
- Department of Neurology, Juntendo Tokyo Koto Geriatric Medical Center
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Abstract
Lesions of the lower cranial nerves (LCN) are due to numerous causes, which need to be differentiated to optimize management and outcome. This review aims at summarizing and discussing diseases affecting LCN. Review of publications dealing with disorders of the LCN in humans. Affection of multiple LCN is much more frequent than the affection of a single LCN. LCN may be affected solely or together with more proximal cranial nerves, with central nervous system disease, or with nonneurological disorders. LCN lesions have to be suspected if there are typical symptoms or signs attributable to a LCN. Causes of LCN lesions can be classified as genetic, vascular, traumatic, iatrogenic, infectious, immunologic, metabolic, nutritional, degenerative, or neoplastic. Treatment of LCN lesions depends on the underlying cause. An effective treatment is available in the majority of the cases, but a prerequisite for complete recovery is the prompt and correct diagnosis. LCN lesions need to be considered in case of disturbed speech, swallowing, coughing, deglutition, sensory functions, taste, or autonomic functions, neuralgic pain, dysphagia, head, pharyngeal, or neck pain, cardiac or gastrointestinal compromise, or weakness of the trapezius, sternocleidomastoid, or the tongue muscles. To correctly assess manifestations of LCN lesions, precise knowledge of the anatomy and physiology of the area is required.
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Affiliation(s)
- Josef Finsterer
- Krankenanstalt Rudolfstiftung, Kaiser-Franz-Josef Spital, Vienna, Austria, Europe
| | - Wolfgang Grisold
- Department of Neurology, Kaiser-Franz-Josef Spital, Vienna, Austria, Europe
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Le AQ, Walcott BP, Redjal N, Coumans JV. Cervical osteophyte resulting in compression of the jugular foramen: Case report. J Neurosurg Spine 2014; 21:565-7. [PMID: 25014503 DOI: 10.3171/2014.6.spine13908] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Jugular foramen syndrome is a condition characterized by unilateral paresis of cranial nerves IX, X, and XI in the setting of extrinsic compression. Here, the authors describe the case of a giant cervical osteophyte resulting in compression of the jugular foramen. A 74-year-old man who presented with progressive dysphagia and dysarthria was found to have right-sided tongue deviation, left palatal droop, and hypophonia. His dysphagia had progressed to the point that he had lost 25 kg over a 4-month period, necessitating a gastrostomy to maintain adequate nutrition. He underwent extensive workup for his dysphagia with several normal radiographic studies. Ultimately, CT scanning and postcontrast MRI revealed a posterior osteophyte arising from the C1-2 joint space and projecting into the right jugular foramen. This resulted in a jugular foramen syndrome in addition to delayed filling of the patient's right internal jugular vein distal to the osteophyte. Although rare, a posterior cervical osteophyte should be considered in cases of jugular foramen syndrome.
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Affiliation(s)
- Andrew Q Le
- Department of Neurosurgery, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts
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