Vagoglossopharyngeal-Associated Syncope Due to a Retained Bullet in the Jugular Foramen

Michael J Link; Colin L.W Driscoll; Yoshua Esquenazi

doi:10.1055/s-0029-1225532

Skull Base, Inhaltsverzeichnis

Skull Base 2010; 20(2): 105-109
DOI: 10.1055/s-0029-1225532

CASE REPORT

Vagoglossopharyngeal-Associated Syncope Due to a Retained Bullet in the Jugular Foramen

Michael J. Link¹ ^, ² , Colin L.W Driscoll¹ ^, ² , Yoshua Esquenazi³

¹Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
²Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
³Department of General Surgery, Mayo Clinic, Rochester, Minnesota

Abstract

ABSTRACT

Gunshot wounds (GSWs) to the head are frequently fatal. Rarely, the bullet may lodge in the skull base and not cause significant brain injury. Typically, the bullet fragments are felt to be inert and do not require operative extirpation if they are within the bony confines of the skull base. We report the case of a bullet in the jugular foramen causing recurrent syncope that resolved after surgical removal of the bullet. The medical records from a patient who suffered a GSW to the head were retrospectively reviewed and the treatment and outcome documented. In 2000, a 20-year-old man suffered a GSW to the head. Immediate evaluation revealed the bullet in the right skull base at the jugular foramen, but no parenchymal brain injury. One year after the GSW, he began to experience stereotypical spells resulting in loss of consciousness. Extensive cardiovascular workup was normal. In 2002, the patient underwent removal of the bullet. He has been syncope-free since the operation and returned to his career in the military. We believe the retained bullet in this patient was irritating the IX–X cranial nerves, resulting in syncope, similar to the mechanism in vagoglossopharyngeal neuralgia. Removing the bullet relieved the irritation and stopped the syncopal spells.

KEYWORDS

Gunshot wounds - jugular foramen - Syncope - vagoglossopharyngeal neuralgia

Volltext

Referenzen

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Michael J LinkM.D.

Department of Neurologic Surgery, Mayo Clinic

200 First Street SW, Rochester, MN 55905

eMail: link.michael@mayo.edu