11/32. Vagal neuropathy after upper respiratory infection: a viral etiology? PURPOSE: To describe a condition that occurs following an upper respiratory illness, which represents injury to various branches of the vagus nerve. patients with this condition may present with breathy dysphonia, vocal fatigue, effortful phonation, odynophonia, cough, globus, and/or dysphagia, lasting long after resolution of the acute viral illness. The patterns of symptoms and findings in this condition are consistent with the hypothesis that viral infection causes or triggers vagal dysfunction. This so-called postviral vagal neuropathy (PVVN) appears to have similarities with other postviral neuropathic disorders, such as glossopharyngeal neuralgia and Bell's palsy. MATERIALS AND methods: Five patients were identified with PVVN. Each patient's chart was reviewed, and elements of the history were recorded. RESULTS: Each of the 5 patients showed different features of PVVN. CONCLUSIONS: Respiratory infection can trigger or cause vocal fold paresis, laryngopharyngeal reflux, and neuropathic pain. ( info) |
| vagus nerve palsy caused by herpes simplex virus (HSV) infection is rare. Here, we present a 29-year-old man with acute onset of right side otalgia and sore throat, followed by dysphonia, dysphagia and some vesicles seen on the deep soft palate. laryngoscopy revealed right vocal cord palsy. neck to chest CT did not reveal local lesion. Three months later, his serum HSV IgG antibody titer was eight times elevation and a throat swab culture for virus isolation yielded HSV type I. T2-weighted images of neck MRI showed abnormally high signal intensity on the right sub-glottis region with gadolinium enhancement that was compatible with local infection. Thereafter, one course of acyclovir; was given. Three months after finishing the acyclovir, his symptoms were almost gone and neck MRI did not show the aforementioned lesions. HSV infection should be considered as a differential diagnosis for patients with idiopathic dysphonia and dysphagia. ( info) |
13/32. Concomitant vagal neurofibroma and aplasia of the internal carotid artery in neurofibromatosis type 1. We report the case of a patient with neurofibromatosis type 1 who had both aplasia of an internal carotid artery (ICA) and a vagal neurofibroma. To our knowledge, this is the first report in the literature of the simultaneous presence of these two rare disorders in a single patient. We believe that this is also the first report of an absence of an ICA in a patient with neurofibromatosis type 1. The patient was a 19-year-old woman who complained of a slowly growing neck mass. The mass occupied the right parapharyngeal space and upper cervical region. The patient had no other masses on physical examination, but widespread cafe au lait spots were evident. This led us to suspect the presence of a vagal neurofibroma. The tumor was removed, and pathology confirmed the diagnosis. No intracranial aneurysms were detected on cerebral angiography. ( info) |
14/32. An unusual bilateral cervical paraganglioma: a case report. Paragangliomas are neoplasms originating from paraganglion tissue derived from mesoderm, the most common location being adjacent to carotid bifurcation. Rarely these tumours can be bilateral. We present here a case of bilateral paraganglioma occurring in a young woman. On one side the tumour was arising from the vagus nerve and on the other, from the carotid body. Clinical, radiological and histopathological features and treatment dilemmas are discussed. ( info) |
15/32. Masked pseudomonal skull base osteomyelitis presenting with a bilateral Xth cranial nerve palsy. skull base osteomyelitis classically presents as a complication of severe external otitis, middle ear, mastoid or sinus infection and can lead to multiple lower cranial nerve palsies when the jugular foramen is involved as a consequence of widespread involvement of the skull base. Bilateral skull base osteomyelitis is a recognized phenomenon, but has not previously been reported secondary to pseudomonal infection in the absence of a clinically obvious focus of infection. We report the case of a 77-year-old diabetic patient who presented with dysphonia and dysphagia and had a bilateral Xth cranial nerve palsy. No focus of infection was evident on presentation. Subsequent radiological investigation confirmed the diagnosis of bilateral skull base osteomyelitis. ( info) |
| Mesenchymal chondrosarcoma is a rare, aggressive, malignant neoplasm, which arises from extraskeletal sites in 30-40 per cent of cases. It is extremely rare in children. We present a novel case of childhood mesenchymal chondsarcoma arising from the vagus nerve in the neck, resulting in paralysis of the right vocal fold. The clinicopathologic features and management of this case are described along with a brief discussion on the aetiology of vocal fold paralysis in this age group. Current literature on extraskeletal presentation of mesenchymal chondrosarcoma is reviewed. ( info) |
17/32. Horner's syndrome following excision of a vagal paraganglionoma. We report a case of excision of a vagal paraganglionoma resulting in Horner's syndrome. The case was initially misdiagnosed as a carotid body tumour and demonstrates the need for adequate preoperative imaging and patient counselling for likely complications of surgery. ( info) |
18/32. Long-lasting improvement of arterial hypertension after surgical treatment of a foramen magnum meningioma: case report. BACKGROUND: Neurogenic arterial hypertension has been proposed to be caused by neurovascular compression in many cases. However, there is little reference to tumors causing hypertension by local compression of the vagal nerve or the ventrolateral medulla oblongata. The following case illustrates the effects of surgery for a meningioma of the foramen magnum on arterial hypertension. CASE DESCRIPTION: A 54-year-old woman suffered from arterial hypertension for at least 7 months, for which she required a combined medical treatment regime. She suffered for 6 months from dizziness and tinnitus, more in the left ear than in the right. neurologic examination revealed a horizontal fixation nystagmus and a mild left-sided hearing loss.magnetic resonance imaging and computed tomographic angiography showed a contrast-enhancing tumor on the left side of the foramen magnum compressing the medulla oblongata close to the vertebral artery and vascularized by branches of the left pica. Complete surgical extirpation was performed using a medial craniocervical approach. The tinnitus and dizziness were gone and hearing improved. Postoperatively, the arterial hypertension showed a long-lasting improvement (observation period 8 months) with only minimal medical treatment. CONCLUSION: Based on our case, we conclude that tumors in close proximity to the ventrolateral medulla oblongata may induce neurogenic hypertension, similar to neurovascular compression. ( info) |
19/32. A case of trigeminal-vagal neuralgia relieved by peripheral self-stimulation. A case of simultaneous trigeminal and vagoglossopharyngeal neuralgia is described. No microvascular compression was seen at the trigeminal complex while the origin of vagoglossopharyngeal pain could have been due either to Chiari malformation or microvascular compression of the IX-X nerve complex. Decompressive surgery was ineffective. The patient could completely block his facial painful fits by strongly pinching the anterior axillary fold. This case militates against peripheral theories of facial neuralgias, including microvascular compression and ganglion ignition focus theories, and supports a central origin thereof. ( info) |
20/32. Unusual cases of cervical nerves schwannomas: phrenic and vagus nerve involvement. Benign neurogenic tumors (neurilemmoma) arising from the cervical phrenic or vagus nerve are relatively rare. These lesions are benign, asymptomatic and incidentally found. We describe two cases considering different surgical techniques adopted. In the case of phrenic nerve schwannoma we performed a total excision of the tumor including the maternal nerve fiber to prevent tumor recurrence, also in regard to the already present hemidiaphragm palsy. On the other hand in second case, in which the vagus nerve was involved, we proposed a microsurgical approach by monitoring nerve function in order to minimize nerve damage. ( info) |