Jugular foramen syndrome

Published on 05/05/2015 by admin

Filed under Internal Medicine

Last modified 05/05/2015

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83 Jugular foramen syndrome

Instruction

Examine this patient’s cranial nerves.

Salient features

History

• Clinical presentation reflects effects on a combination of the last four cranial nerves:

• Hoarseness of voice
• Nasal quality to the speech
• Nasal regurgitation and dysphagia
• Aspiration of food with choking attacks
• Weakness of the sternomastoids and trapezii
• Wasting of the tongue (often noticed by the dentist)
• Pain in and around the ear (caused by damage of the ninth and tenth cranial nerves, which carries sensation to the external auditory meatus and behind the ear)
• Headache
• Ptosis (caused by Horner syndrome).

Examination

• Sluggish movement of the palate when the patient says ‘aah’ on the affected side

• Absent gag reflex on the same side

• Flattening of the shoulder on the same side

• Wasting of the sternomastoid (Fig. 83.1)

• Weakness when the patient moves her chin to the opposite side

• Difficulty in shrugging the shoulder on the same side (Fig. 83.2).

image

Fig. 83.1 Wasting of the sternomastoid. (A) Normal left muscle with forceful thrust of chin to the right. (B) Movement to the left shows loss of muscle bulk.

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