An unusual cause of dysphagia and dysphonia

The glossopharyngeal, vagus, and accessory cranial nerves pass through the jugular foramen and may be involved by transforaminal tumors.1,2 Weakness of the muscles supplied by these cranial nerves may simulate the bulbar variant of ALS or myasthenia gravis.Here we report a 94-year-old woman with a schwannoma of the left jugular foramen (figure , A, B, C, D) who presented with a 4-year history of worsening dysphonia and mild dysphagia.Clinical examination revealed weakness and hypotrophy of the left sternocleidomastoid and trapezius (see figure , E), dysphagia and dysphonia with the left vocal cord in adduction, hypoesthesia of pharyngeal left posterior mucosa, bilateral hearing loss (more severe on the left), and tinnitus.EMG showed total denervation in the upper part of the left trapezius muscle.Stereotactic radiosurgery was planned.