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A 60-year-old woman presented with a 4-year history of right-sided pulsatile tinnitus and progressive hearing loss. She reported 2 years of worsening nasal reflux, dysphonia, dysphagia, right shoulder weakness, dysarthria, and difficulty moving her tongue. Physical examination was significant for a red pulsatile middle ear mass. Examination also revealed palatal asymmetry, right vocal cord paralysis, right shoulder depression with trapezius atrophy, and tongue deviation to the right, findings consistent with right-sided paralysis of cranial nerves IX through XII, respectively (Figure and Supplemental Video, available online at http://www.mayoclinicproceedings.org). Imaging revealed a large erosive lesion centered on the jugular foramen with extension into the middle ear. A jugular paraganglioma with lower cranial nerve involvement was diagnosed. In this case, the tumor resulted in Collet-Sicard syndrome, a rare jugular foramen syndrome describing paralysis of cranial nerves IX, X, XI, and XII.
Supplemental material can be found online at: http://www.mayoclinicproceedings.org. Supplemental material attached to journal articles has not been edited, and the authors take responsibility for the accuracy of all data.
Potential Competing Interests: The authors report no competing interests.