FREDERIC B.ASKINMDWILLIAM H.WESTRAMD
A 77-YEAR-OLD white woman who presented with persistent hoarseness and dysphagia was found to have a left vocal fold paralysis. Evaluation, including an unenhanced computed tomographic (CT) scan of the brain and a magnetic resonance imaging (MRI) scan, revealed a left cerebellopontine angle mass involving the jugular foramen. The patient declined surgical intervention at that time. Over the next 30 months, dysphagia and recurrent aspiration necessitated placement of a percutaneous gastrostomy feeding tube. The patient developed headaches, visual blurring, paresis of left cranial nerve XII, and left-sided sensorineural hearing loss. She also became wheelchair bound owing to progressive vertigo and ataxia. She then sought treatment for relief of her symptoms. The CT scan revealed a left-sided erosive mass with widening of the jugular foramen and involvement of the lateral clivus and medial petrous bones. There was inhomogeneous enhancement and scattered foci of calcification. The MRI scan exhibited a lobulated mass at the cerebellopontine angle and jugular foramen, with extension into the posterior cranial fossa and compression of the brainstem. The mass was isointense and inhomogeneously enhancing on T1-weighted images and hyperintense on T2-weighted images (Figure 1) Concurrent magnetic resonance angiography exhibited no vascular blush associated with the lesion.
Donaldson DR, Myers LL, Diaz-Ordaz E, Grand W, Paterson J, Wax MK. Pathologic Quiz Case 2. Arch Otolaryngol Head Neck Surg. 1999;125(2):229-231. doi: