Case Report - Trauma Induced Vernet’s Syndrome

Abstract

Trauma induced Vernet’s syndrome is a rare presentation and very few case reports exist in medical literature. Here we report a 40-year-old male with no significant medical history who presented with clinical features of right IX, X, and XI cranial nerve palsy after trauma to the neck and was diagnosed with right internal jugular vein thrombosis on imaging causing compression and symptoms. Patient symptomatically improved with anti-coagulation and was advised regular follow-up.

This case report emphasizes on the need for identifying trauma induced thrombosis as one of the uncommon causes of Vernet’s syndrome with better prognosis and the need for early imaging techniques in such cases.

The jugular foramen-crossing IX, X, and XI cranial nerves are paralyzed in Vernet syndrome. The posterolateral sulcus of the medulla oblongata is where the glossopharyngeal nerve, vagus nerve, and spinal accessory nerves emerge. They then travel via the basal cistern before leaving the skull by the jugular foramen.^[1] Primary tumours like paraganglioma, meningioma, and schwannoma, metastatic tumours at the base of the skull, inflammation like meningitis and malignant otitis external, sarcoidosis, Guillain-Barre syndrome, vascular events like dissection, thrombosis, or aneurysm, and trauma are the main causes of Vernet syndrome.

Vernet syndrome caused by trauma is incredibly rare and is typically brought on by penetrating trauma or fractures impacting the posterior skull base. Approximately 30 cases of Jugular foramen syndrome caused by a fracture in the jugular foramen area have been documented to date.^[2,3] Only one posttraumatic Vernet case without a fracture has, however, been documented so far,^[4] and this is one of them.