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Recurrent Facial Palsy Due to High Jugular Bulb Dehiscence

Authors Alkhamis F, Alhajri K, Aljaafari D, Alhashim A, Alsamarah A, Sharydah A, Basheir O, AlSulaiman F, Alabdali M

Received 10 December 2020

Accepted for publication 2 February 2021

Published 16 February 2021 Volume 2021:14 Pages 359—362


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Fahd Alkhamis,1 Khalid Alhajri,1 Danah Aljaafari,1 Ali Alhashim,1 Adnan Alsamarah,2 Abdulaziz Sharydah,2 Osama Basheir,1 Feras AlSulaiman,1 Majed Alabdali1

1Department of Neurology, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2Department of Radiology, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia

Correspondence: Majed Alabdali
Neurology Departments, King Fahad Hospital of the University – Imam Abdulrahman Bin Faisal University, PO Box 40236, Dammam, 31952, Kingdom of Saudi Arabia
Tel +966-534347474

Background: A high mega jugular Bulb is an enlarged and swollen upper portion of the internal jugular vein with a variation of its anatomical position among the population, mostly situated below the hypotympanum. Although most cases of jugular bulb diverticulum are asymptomatic, excessive pressure on the surrounding structures might cause various symptoms, most prominently vertigo, sensorineural hearing loss, or tinnitus.
Case Report: A middle-aged male who was referred to the Department of Neurology with a recurrent complaint of left-sided facial weakness associated with headache and vertigo for a period of 24 months. His symptoms were episodic, furthermore exacerbated by visiting high altitude sites. Non-resolving with conventional medical treatment. After thorough investigation, including preoperative and postoperative audiograms, neuroimaging, including computed tomography as well as magnetic resonance angiography, he was diagnosed to have right-sided superior mega jugular bulb as a causative factor. After surgical management, the patient improved significantly. At his regular follow-up in our clinic there were no exacerbations of his symptoms.
Conclusion: Among patients who present with recurrent non-resolving facial palsy in which no apparent causative factor is identified, high jugular bulb should be suspected and investigated. Comprehensive and detailed medical history is essential for raising the suspicion for the diagnosis. Such as the case presented eliciting high altitudes as the main precipitating factor. The diagnosis is clinically elusive, commonly obscured by other common diagnoses. Surgery is recommended if antihypertensive drugs do not show improvement.

Keywords: internal jugular vein, high jugular bulb, facial nerve palsy, high jugular bulb dehiscence, headache, surgery

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