High Mega Jugular Bulb Presenting with Facial Nerve Palsy and Severe Headache

Abstract

We present a rare case of a 50-year-old female patient with symptomatic high mega jugular bulb requiring surgery. We review her medical file, preoperative and postoperative imaging, audiograms, and surgical report. High jugular bulb was diagnosed with computed tomography and magnetic resonance imaging. Symptoms of facial nerve palsy and headache were abolished after surgical procedure. Headache and facial nerve palsy can be caused by high mega jugular bulb. Surgery is indicated in such symptomatic cases and leads to relief of signs and symptoms of disease.

Glomus Jugulare Presenting with Isolated Facial Nerve Palsy

“…It is a subset of tumors known as paragangliomas, which are tumors that arise from neural crest cells associated with autonomic ganglia. Due to the anatomical location of glomus jugulare within the jugular foramen, growth of this tumor typically involves CN VII, IX, X, XI, which are in the vicinity of the tumor [ 1 – 4 ].…”

“…The tumor is able to compress and affect the facial nerve due to the proximity of the jugular foramen to the path of the nerve [ 1 , 6 ]. The facial nerve travels into the internal acoustic meatus through the facial canal then out through the stylomastoid foramen.…”

“…The jugular foramen is a large aperture in the base of the skull and it is formed anteriorly by the petrous portion of the temporal bone and behind by the occipital bone. It has [ 1 ] compartments from front to back that contain the inferior petrous sinus, the cranial nerves IX, X, XI, and the sigmoid sinus (which becomes the internal jugular vein), respectively.…”

Resonancia magnética en hipoacusia y vértigo

“…El golfo de la yugular alto es una variante de la normalidad que se considera cuando su margen se extiende hasta la superficie inferior del anillo óseo, protruyendo en el oído medio o en la espira basal de la có-clea. Si el golfo de la yugular presenta un aumento de su diámetro transversal se denomina megagolfo, independientemente de su posición [5]. En la mayoría de los casos, los pacientes permanecen asintomáticos, pero en otros casos pueden presentar diferente sintomatología dependiendo de la localización [6].…”

“…En esta posición, el divertículo se relaciona directamente con la pared posterior del conducto auditivo interno (CAI). La invasión del CAI puede contribuir al déficit neurosensorial de la audición y otros síntomas [5], sin que se detecte en la otoscopia ya que puede no llegar hasta el oído medio [8]. Es fundamental un diagnóstico radiológico para evitar otras pruebas innecesarias [7].…”