Clinic of Otorhinolaryngology and Head and Neck Surgery, Rijeka University Hospital Center, Rijeka, Croatia.
University of Rijeka, Faculty of Medicine, Rijeka, Croatia.
Medicine (Baltimore). 2021 Oct 29;100(43):e27618. doi: 10.1097/MD.0000000000027618.
The aim of this case is to emphasize the need to include nerve traction in the differential diagnosis of nerve deficits associated with Vernet syndrome. This mechanism of injury has been described only once, but must not be overlooked and should be considered and included as a possible cause in diagnostic algorithms.
A patient presenting with dysphagia, extreme hoarseness, and limited shoulder movement after head injury was admitted to the emergency department.
Multidisciplinary evaluation was performed, and nerve traction-induced Vernet syndrome was established as a running diagnosis.
Intensive swallowing and speech exercises, assisted by a specialist, were performed.
Swallowing and speech exercises significantly and objectively improved the patient's swallowing and voice, with mild hoarseness of voice remaining as the main symptom. Spectral acoustic analysis went from a voice pitch of 163.77 Hz to normal (187.77 Hz), jitter improved from 17.87% to 0.86% and shimmer values decreased from 39.86% to 19.60%. Breathiness during phonation measuring 2.91% was reduced to 1.08% and appropriate average intensity of voice (63.95 dB) was achieved. Initial dysphagia and fluid retention in the right piriform sinus, along with tracheal aspiration, were not observed in control fiberoptic endoscopic evaluation of swallowing.
According to our knowledge and literature data, this is the second reported case of posttraumatic Vernet syndrome without radiologically confirmed jugular foramen fracture, induced by nerve traction. Such patients need a prompt multidisciplinary approach in diagnosis and timely posttraumatic rehabilitation therapy for favorable clinical evolution and retrieval of nerve function.
本病例旨在强调在与 Vernet 综合征相关的神经功能缺损的鉴别诊断中应包括神经牵引。这种损伤机制仅被描述过一次，但不能被忽视，应在诊断算法中被视为并列为可能的病因。
一名头部受伤后出现吞咽困难、极度声音嘶哑和肩部运动受限的患者被收入急诊部。
进行了多学科评估，并确立了神经牵引所致 Vernet 综合征作为初始诊断。
进行了强化吞咽和言语练习，由专家协助。
吞咽和言语练习显著和客观地改善了患者的吞咽和声音功能，仅留有轻度声音嘶哑作为主要症状。声谱分析显示，嗓音基频从 163.77 Hz 恢复至正常（187.77 Hz），抖动从 17.87%改善至 0.86%，晃度值从 39.86%降至 19.60%。发声时的粗糙声测量值从 2.91%降低至 1.08%，并实现了适当的平均嗓音强度（63.95 dB）。在控制纤维内镜吞咽评估中，初始时观察到的右梨状隐窝积液和气管抽吸均未出现。
根据我们的知识和文献数据，这是第二例无放射学证实的颈静脉孔骨折的创伤后 Vernet 综合征报告，由神经牵引引起。此类患者需要及时进行多学科诊断和创伤后康复治疗，以获得良好的临床转归和神经功能恢复。
