Glomus Jugulare Tumor Presentation and Management: A Case Study

Mark C. Coles

Disclosures

J Neurosci Nurs. 2004;36(4) 

In This Article

Case Presentation

A 40-year-old right-handed female was referred for neurosurgical consultation following an 8-month history of intermittent vertigo. She also described "stuffiness" in the left ear, subjective hoarseness undetectable to friends, and intermittent dysphagia. In fact, approximately 3-4 months prior to the initial office consultation, she had presented to a local emergency room for a presumed food bolus obstruction and underwent esophagoscopy. No bolus was found, no stricture was evident, and there was no evidence for esophagitis, yet the patient continued to describe dysphagia. She had to "think about swallowing." Her primary care physician next referred her to an otolaryngology specialist for evaluation. Initial audiogram and tuning fork tests were normal. At this point she was sent for a magnetic resonance imaging (MRI) scan of the brain and internal auditory canals. She was subsequently referred for neurosurgery consultation after the study revealed a 1.8 x 1.0 x 1.5 cm enhancing lesion in the left jugular fossa (Fig 1). Given the location, combined with slight bony remodeling of the jugular foramen suggestive of a slow growing lesion, the appearance was thought to be consistent with a glomus jugulare tumor (Fig 2).

Coronal view, contrasted MRI study, demonstrating left jugular foramen tumor (arrow)

Contrasted MRI study, axial view, of typical glomus jugulare lesion

Presenting symptoms of glomus jugulare tumors depend upon the precise location and extent of the lesion and commonly include hearing loss, pulsatile tinnitus, and dizziness, as well as various combinations of lower cranial nerve (CN) palsies, specifically of IX, X, XI, and XII. Erosive extension into the temporal bone may also produce CN VII palsy. Horner's syndrome may be present (Al-Mefty & Teixera, 2002). The tumor can at times be visualized behind the tympanic membrane. If the tumor is mistakenly biopsied, catastrophic hemorrhage may result.

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