Department of Otolaryngology - Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, USA.
Georgetown University School of Medicine, Washington, DC, USA.
Ann Otol Rhinol Laryngol. 2021 Feb;130(2):215-218. doi: 10.1177/0003489420942546. Epub 2020 Jul 13.
To present a novel location in which neurosarcoidomatous inflammation is identified and its accompanying presentation.
The authors present a case of bilateral vocal fold paresis associated with non-caseating granulomatous inflammation of the cervical and intra-axial portions of the vagus nerve masquerading as a cranial nerve tumor.
Examination revealed bilateral vocal fold paresis and asymmetric palate elevation. MRI demonstrated enhancing bilateral jugular foramen masses, and neck ultrasound demonstrated bilateral thickened appearance of the vagus nerves. Vagus nerve biopsy demonstrated non-caseating granulomas.
Neurosarcoidosis may contribute to variable cranial neuropathies. Vocal fold paresis is usually thought to arise from mediastinal compression of the left recurrent laryngeal nerve. Rarely, though, lesions may arise in other parts of the vagus nerve. Failure of response to steroids does not rule out the diagnosis, making tissue diagnosis important in some cases.
介绍神经肉样瘤病炎症的一个新位置及其伴随表现。
作者介绍了一例双侧声带麻痹，伴有颈段和延髓内迷走神经的非干酪样肉芽肿性炎症，表现为颅神经肿瘤。
检查发现双侧声带麻痹和不对称的软腭抬高。MRI 显示双侧颈静脉孔增强肿块，颈部超声显示双侧迷走神经增厚。迷走神经活检显示非干酪样肉芽肿。
神经肉样瘤病可能导致多种颅神经病变。声带麻痹通常被认为是由于左侧喉返神经的纵隔受压引起的。然而，病变也可能发生在迷走神经的其他部位。对类固醇治疗反应不佳并不能排除诊断，因此在某些情况下组织诊断很重要。
