An 81-year-old woman was admitted with shortness of breath and fever

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An 81-year-old woman was admitted with shortness of breath and fever An 81-year-old woman was admitted with shortness of breath and fever. She was found to have a right middle lobe pneumonia, the third pneumonia in three months. Neurologic examination revealed a vocal cord paralysis on the right side; the gag reflex was absent and there was loss of bulk of the trapezius and sternocleidomastoid muscles on the right side; the tongue appeared slightly atrophic on the right and deviated to the right upon protrusion; there was asymmetric elevation of the soft palate (deviation to the left due to paralysis on the right side). The patient aspirated during a swallowing evaluation. Magnetic resonance imaging demonstrated a mass lesion within the jugular foramen and the petrous bone on the right side [left image, arrow heads]. Computed tomography of the base of the skull showed osteolytic changes within the right petrous temporal and occipital bone [right: arrow heads; asterisk: jugular foramen]. A biopsy confirmed the clinically suspected diagnosis of glomus jugulare tumor which had impaired function of the ninth, tenth, eleventh, and twelfth cranial nerves. The patient was treated with radiation. (Used with permission of Dr. Joachim Baehring.) Source: Ventricles and Coverings of the Brain, Clinical Neuroanatomy, 28e Citation: Waxman SG. Clinical Neuroanatomy, 28e; 2017 Available at: http://accessmedicine.mhmedical.com/DownloadImage.aspx?image=/data/books/1969/waxman28_ch11_f018.png&sec=147037142&BookID=1969&ChapterSecID=147037023&imagename= Accessed: December 22, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved