A patient with jugular foramen syndrome was treated surgically. The histological diagnosis was neurinoma arising from the vagus. The differential diagnosis between jugular foramen syndrome and acoustic neurinoma was made on the basis of neuro-otological and neuroradiological data.
The patient was a 49-year-old female who complained of tinnitus and hearing impairment, which was followed by hoarseness, dysphagia and weakness of the right sternocleidomastoid muscle. Neurological examinations showed disturbances of cranial nerves VIII, IX, X, and XI.
Neuro-otological examinations revealed sensorineural hearing impairment in the low frequency range, no nystagmus response to caloric stimulation on the right, and slightly decreased high velocity gain of optokinetic responses toward the side contralateral to the lesion.
Polytomography of the jugular foramen showed enlargement of the right jugular foramen. Retrograde jugularography showed complete occlusion of the right jugular vein. The tumor was totally removed and histologically confirmed to be a neurinoma originating in the Xth cranial nerve.
In the previously published literature, neurinomas arising from the jugular foramen were difficult to differentiate from acoustic neurinomas, especially in the absence of lower cranial nerve signs. Therefore, Polytomography of the jugular foramen and jugularography provide valuable data in the differential diagnosis between acoustic neurinoma and the jugular foramen syndrome.
