Objective:

N/A

Background:

Paragangliomas are rare neuroendocrine tumors that can originate from sympathetic or parasympathetic ganglia. The most common locations for head and neck paragangliomas are within the carotid body, temporal bone, or vagus nerve. These are typically asymptomatic, though can present with symptoms related to compression of nearby structures.

Design/Methods:

N/A

Results:

A 90-year-old female with hyperlipidemia and migraines presented to the ED with several months of progressive dysphagia, dysarthria and right sided occipital and neck pain. Neurological examination showed isolated right sided tongue deviation, without atrophy or fasciculations. Head computed tomography (CT) revealed a smoothly marginated mass within the right parapharyngeal region that extended into the right jugular foramen. CT angiography demonstrated a soft tissue mass of increased vascularity within the right carotid space. This was followed by MRI brain remarkable for a T2 hyperintense mass within the high right cervical region, splaying the internal and external carotid arteries. Furthermore, MRI face and neck revealed a 3.1 cm x 2.6 cm T2 hyperintense mass below the right side of the skull base with intense heterogenous enhancement and anteromedial displacement of the right internal carotid artery. Patient was diagnosed with a RIGHT hypoglossal nerve dysfunction due to compression by soft tissue neck mass suggestive of a paraganglioma. Treatment included low dose steroids and radiation therapy. At three month follow up, there was notable improvement in her dysphagia, dysarthria and tongue deviation.  

Conclusions:

Head and neck paragangliomas are rare tumors, the majority of which present as asymptomatic neck masses. Infrequently, patients can present with symptoms related to compression of nearby cranial nerves (VII, IX, X, XI, and XII). Treatment is generally observation for asymptomatic tumors, though surgical resection, radiation therapy, or a combination of the two may be considered.