Jugulotympanic paraganglioma: a rare cause of vertigo

Abstract

Background: Jugulotympanic paraganglioma generally presents in the 5th or 6th decades of life with tinnitus and hearing loss. In this manuscript, we present a rare case of jugulotympanic paraganglioma presenting in the 9th decade with vertigo as the most bothersome symptom.

Case report: An 83-year-old woman presented with worsening episodes of dizziness of a few months duration. She also complained of tinnitus and hearing loss, more severe on the left side. Examination revealed a red bulging left-sided tympanic membrane, conductive hearing loss, and a bruit at the base of the skull. Dix-Hallpike test was negative. CT head and MRI brain revealed findings consistent with a large left-sided jugulotympanic paraganglioma, which was found to be hormonally inactive on laboratory tests. The patient underwent treatment with radiotherapy, which resulted in partial improvement of symptoms.

Conclusions: Jugulotympanic paraganglioma may manifest in the elderly with the chief complaint of intermittent vertigo, as in our case. A red bulging mass on otoscopy raises the suspicion, necessitating further investigations, including CT and MRI.

Figure 1.

MRI brain with gadolinium contrast; fast spin-echo fat-suppressed T2 axial sequence demonstrating minimally hyperintense lesion in the cervical region with maximum transverse dimension of approximately 12×16 mm.

Figure 2.

MRI brain with gadolinium contrast; fast spin-echo fat-suppressed T2 axial sequence demonstrating a lesion at the skull base, at jugular foramen level, dimensions approximately 26×14 mm.

Figure 3.

MRI brain with contrast; T1 coronal sequence demonstrating a mass close to the external auditory canal with diffuse minimal somewhat heterogeneous enhancement.

Figure 4.

MRI brain with contrast; T1 coronal sequence revealing a mass in the carotid spaces with cephalocaudad dimension of approximately 50–60 mm. The caudad margin of the mass begins approximately 15–20 mm superior to the carotid bifurcation. The mass extends cephalad through the jugular foramen and left aspect of the basilar cistern with erosion into the hypotympanum and mesotympanum.