J Am Acad Audiol 2018; 29(02): 187-191
DOI: 10.3766/jaaa.16012
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Cervical Vestibular Evoked Myogenic Potential in Hypoglossal Nerve Schwannoma: A Case Report

Aravind Kumar Rajasekaran
*   Department of Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bangalore, India
,
Amey Rajan Savardekar
†   Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
,
Nagaraja Rao Shivashankar
*   Department of Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bangalore, India
› Author Affiliations
Further Information

Publication History

Publication Date:
29 May 2020 (online)

Abstract

Background:

Schwannoma of the hypoglossal nerve is rare. This case report documents an atypical abnormality of the cervical vestibular evoked myogenic potential (cVEMP) in a patient with schwannoma of the hypoglossal nerve. The observed abnormality was attributed to the proximity of the hypoglossal nerve to the spinal accessory nerve in the medullary cistern and base of the skull.

Purpose:

To report cVEMP abnormality in a patient with hypoglossal nerve schwannoma and provide an anatomical correlation for this abnormality.

Research Design:

Case report.

Study Sample:

A 44-yr-old woman.

Data Collection:

Pure-tone and speech audiometry, tympanometry, acoustic stapedial reflex, auditory brainstem response, and cVEMP testing were performed.

Results:

The audiological test results were normal except for the absence of cVEMP on the lesion side (right).

Conclusions:

A cVEMP abnormality indicating a compromised spinal accessory nerve was observed in a patient with hypoglossal nerve schwannoma. This case report highlights the importance of recording cVEMP in relevant neurological conditions and provides clinical proof for the involvement of the spinal accessory nerve in the vestibulocollic reflex pathway.

 
  • REFERENCES

  • Awobuluyi MT. 2013. Tumors of cranial/spinal nerves. In: Naidich TP, Castillo M, Cha S, Smirniotopoulos JG. Imaging of the Brain. Philadelphia, PA: Saunders; 826-836
  • Boban M, Brinar VV, Habek M, Rados M. 2007; Isolated hypoglossal nerve palsy: a diagnostic challenge. Eur Neurol 58 (03) 177-181
  • Chiarovano E, Darlington C, Vidal PP, Lamas G, de Waele C. 2014; The role of cervical and ocular vestibular evoked myogenic potentials in the assessment of patients with vestibular schwannomas. PLoS One 9 (08) e105026
  • Chu CK, Tseng HM, Young YH. 2006; Clinical presentation of posterior fossa epidermoid cysts. Eur Arch Otorhinolaryngol 263 (06) 548-551
  • Colebatch JG, Halmagyi GM. 1992; Vestibular evoked potentials in human neck muscles before and after unilateral vestibular deafferentation. Neurology 42 (08) 1635-1636
  • Colebatch JG, Halmagyi GM, Skuse NF. 1994; Myogenic potentials generated by a click-evoked vestibulocollic reflex. J Neurol Neurosurg Psychiatry 57 (02) 190-197
  • Colebatch JG. 2001; Vestibular evoked potentials. Curr Opin Neurol 14 (01) 21-26
  • Curthoys IS. 2010; A critical review of the neurophysiological evidence underlying clinical vestibular testing using sound, vibration and galvanic stimuli. Clin Neurophysiol 121 (02) 132-144
  • Curthoys IS, Vulovic V, Burgess AM, Sokolic L, Goonetilleke SC. 2016; The response of guinea pig primary utricular and saccular irregular neurons to bone-conducted vibration (BCV) and air-conducted sound (ACS). Hear Res 331: 131-143
  • Deftereos SN, Panagopoulos G, Eleftheriadou A, Korres S, Georgonikou D, Kandiloros D, Karageorgiou CE. 2008; Using vestibular evoked myogenic potentials to localise brainstem lesions. A preliminary report. B-ENT 4 (04) 215-219
  • Felipe L, Gonçalves DU, Tavares MC, Sousa-Pereira SR, Antunes CM, Lambertucci JR. 2009; Vestibular-evoked myogenic potential (VEMP) in the evaluation of schistosomal myeloradiculopathy. Am J Trop Med Hyg 81 (04) 551-554
  • Gupta C, Kurian P, Seva KN, Kalthur SG, D’Souza AS. 2014; A morphological and morphometric study of jugular foramen in dry skulls with its clinical implications. J Craniovertebr Junction Spine 5 (03) 118-121
  • Güven H, Bayır O, Aytaç E, Ozdek A, Comoğlu SS, Korkmaz H. 2014; Vestibular-evoked myogenic potentials, clinical evaluation, and imaging findings in multiple sclerosis. Neurol Sci 35 (02) 221-226
  • Hoshi M, Yoshida K, Ogawa K, Kawase T. 2000; Hypoglossal neurinoma—two case reports. Neurol Med Chir (Tokyo) 40 (09) 489-493
  • Hu YF, Cheng PW, Young YH. 2009; Comparison of vestibular function between large cerebellopontine angle meningioma and schwannoma. Acta Otolaryngol 129 (02) 161-165
  • Karasu A, Cansever T, Batay F, Sabanci PA, Al-Mefty O. 2009; The microsurgical anatomy of the hypoglossal canal. Surg Radiol Anat 31 (05) 363-367
  • Kim S, Lee HS, Kim JS. 2010; Medial vestibulospinal tract lesions impair sacculo-collic reflexes. J Neurol 257 (05) 825-832
  • Magnano I, Pes GM, Pilurzi G, Cabboi MP, Ginatempo F, Giaconi E, Tolu E, Achene A, Salis A, Rothwell JC, Conti M, Deriu F. 2014; Exploring brainstem function in multiple sclerosis by combining brainstem reflexes, evoked potentials, clinical and MRI investigations. Clin Neurophysiol 125 (11) 2286-2296
  • Mayadevi C. 1978. ISHA PB word list-4. In: Kacker SK, Basavaraj V. Indian Speech, Language and Hearing Tests: The ISHA Battery. Mysore, India: Indian Speech and Hearing Association;
  • Murofushi T, Shimizu K, Takegoshi H, Cheng PW. 2001; Diagnostic value of prolonged latencies in the vestibular evoked myogenic potential. Arch Otolaryngol Head Neck Surg 127 (09) 1069-1072
  • Osborn AG. 2013. Cranial nerves and nerve sheath tumors. In: Osborn AG. Osborn’s Brain: Imaging, Pathology and Anatomy. 1st ed. Manitoba, Canada: Amirsys Inc; 613-644
  • Padmaja B. 1987. ISHA spondee word list-7. In: Kacker SK, Basavaraj V. Indian Speech, Language and Hearing Tests: The ISHA Battery. Mysore, India: Indian Speech and Hearing Association;
  • Pollak L, Prohorov T, Kushnir M, Rabey M. 2009; Vestibulocervical reflexes in idiopathic Parkinson disease. Neurophysiol Clin 39 4–5 235-240
  • Rhoton Jr AL. 2000; The posterior fossa cisterns. Neurosurgery 47 (Suppl 3) S287-S297
  • Ribeiro RS, Pereira MM, Pedroso JL, Braga-Neto P, Barsottini OGP, Manzano GM. 2015; Cervical and ocular vestibular evoked potentials in Machado-Joseph disease: functional involvement of otolith pathways. J Neurol Sci 358 1–2 294-298
  • Roche PH, Mercier P, Sameshima T, Fournier HD. 2008; Surgical anatomy of the jugular foramen. Adv Tech Stand Neurosurg 33: 233-263
  • Sartucci F, Logi F. 2002; Vestibular-evoked myogenic potentials: a method to assess vestibulo-spinal conduction in multiple sclerosis patients. Brain Res Bull 59 (01) 59-63
  • Sato H, Imagawa M, Isu N, Uchino Y. 1997; Properties of saccular nerve-activated vestibulospinal neurons in cats. Exp Brain Res 116 (03) 381-388
  • Sato M, Kanai N, Fukushima Y, Matsumoto S, Tatsumi C, Kitamura K, Ozaki M, Hayakawa T. 1996; Hypoglossal neurinoma extending intra- and extracranially: case report. Surg Neurol 45 (02) 172-175
  • Sheykholeslami K, Megerian CA, Zheng QY. 2009; Vestibular evoked myogenic potentials in normal mice and Phex mice with spontaneous endolymphatic hydrops. Otol Neurotol 30 (04) 535-544
  • Shinoda Y, Ohgaki T, Sugiuchi Y, Futami T. 1989; Comparison of the branching patterns of lateral and medial vestibulospinal tract axons in the cervical spinal cord. Prog Brain Res 80: 137-147 , discussion 127–128
  • Standring S, Berkovitz KB. 2005. Neck. In: Standring S. Gray’s Anatomy: The Anatomical Basis of Clinical Practice. 39th ed. Spain: Elsevier Churchill Livingstone; 531-566
  • Su CH, Chen CM, Young YH. 2013; Differentiating cerebellopontine angle meningioma from schwannoma using caloric testing and vestibular-evoked myogenic potentials. J Neurol Sci 335 1–2 155-159
  • Tsubota M, Shojaku H, Hori E, Fujisaka M, Hayashi N, Kurimoto M, Hatakeyama N, Yamazaki M, Nishijo H, Ono T, Yamamoto H, Watanabe Y. 2007; Effects of vestibular nerve section on sound-evoked myogenic potentials in the sternocleidomastoid muscle of monkeys. Clin Neurophysiol 118 (07) 1488-1493
  • Uchino Y, Sato H, Sasaki M, Imagawa M, Ikegami H, Isu N, Graf W. 1997; Sacculocollic reflex arcs in cats. J Neurophysiol 77 (06) 3003-3012
  • Welgampola MS, Ramsay E, Gleeson MJ, Day BL. 2013; Asymmetry of balance responses to monaural galvanic vestibular stimulation in subjects with vestibular schwannoma. Clin Neurophysiol 124 (09) 1835-1839