Unilateral Vocal Cord Palsy and Dysphagia: A Rare Cerebello-Pontine Angle Meningioma and Its Management
Objectives: Review of an interesting case of an otherwise fit and well 78 year old non-smoking, tee-total female who presented with a 6 month history of hoarseness and dysphagia to an outpatient ENT voice clinic.
Methods: Review of current literature regarding cerebello-pontine angle tumors, their presentation and management. The patient was managed conservatively following direct laryngoscopy, urgent CT and MRI head and neuro-oncological MDT discussion.
Results: Investigations resulted in diagnosis of a left sided cerebellopontine angle (CPA) meningioma arising from the jugular foramen and compressing the brainstem. Upon diagnosis, the patient required a percutaneous endoscopic gastrostomy due to the risk of aspiration. Following discussion with a local neuro-oncological MDT the patient was treated conservatively and deemed not for translabrynthine debulking. She was discharged with dexamethasone and the possibility of a ventriculo-peritoneal (VP) shunt if the patient develops worsening symptoms of raised intracranial pressure (ICP).
Review of the literature suggests that this is an unusual presentation of a CPA tumor. However, there are varied opinions on how this condition should be managed with both conservative treatment and translabrynthine debulking being favored.
Conclusions: Hoarseness has been described in lower cranial nerve schwannomas, however, there have been no cases of unilateral paralysis and hoarseness being the primary presenting symptom of meningioma. It seems therefore prudent that ENT surgeons should consider a primary CPA tumor when presented with a similar patient.
References1 Fan MC, Zhang X, Wang QL, et al. Malignant meningioma of the cerebellopontine angle in a 2-year-old girl: a case report and literature review. 2013. Chin J Cancer
2 Hallinan JT, Hegde AN, Lim WE. Dilemmas and diagnostic difficulties in meningioma. Clin Radiol 2013;13:110–114