(Kiosk 3) Shoulder Pain: Residual Neurological Deficit of Vernet Syndrome

Case Diagnosis: Vernet syndrome secondary to schwannoma in a 17-year-old female

Case Description or Program Description: A 17-year-old female presented with back and shoulder pain, paresthesia, weakness, dysphagia, and hoarseness. It was initially attributed to a COVID-19 infection, but after two years of progressively worsening symptoms, additional workup was obtained and MRI of the brain revealed a right jugular foramen schwannoma.

Setting: Outpatient Rehabilitation Clinic

Assessment/Results: The diagnosis of Vernet syndrome was made based on the clinical and MRI findings. Physical examination was significant for right periscapular atrophy with lateral scapular winging. Due to persistent shoulder symptoms after the resection, nerve conduction studies and electromyography showed significant axonal loss of the right accessory nerve. She was enrolled in an outpatient therapy program for shoulder dyskinesia and pain. Her dysphagia resolved.

Discussion (relevance): Vernet syndrome, also known as jugular foramen syndrome, refers to the paralysis of cranial nerves IX, X, and XI. It is a rare manifestation of a tumor that traverses the jugular foramen. Due to its scarcity, it is often underdiagnosed. Clinical manifestations depend on the structures it affects. The prognosis depends on the type and severity of compression. Early recognition and management of the syndrome are crucial to prevent further or long-lasting neurological deficits and improve outcomes.

Conclusions: In this case, the diagnosis of Vernet syndrome was delayed resulting in residual neurologic deficits. This highlights the importance of early recognition and surveillance to improving care for patients with this condition.