Atypical presentation of a posterior fossa tumour: A case report

Abstract

BACKGROUND

We described a case of a patient with a meningioma in the posterior fossa presenting atypically with an isolated unilateral vocal cord palsy causing severe respiratory distress. This is of interest as the patient had no other symptomatology, especially given the size of the mass, which would typically cause a pressure effect leading to neurological and auditory symptoms.

CASE SUMMARY

This case report described a 48-year-old male who was married with two children and employed as a car guard. He had a medical history of asthma for the past 10 years controlled with an as-needed beta 2 agonist metered dose inhaler. He initially presented to our facility with severe respiratory distress. He reported a 1-wk history of shortness of breath and wheezing that was not relieved by his bronchodilator. He had no constitutional symptoms or impairment of hearing. On clinical examination, the patient’s chest was “silent.” Our initial assessment was status asthmaticus with type 2 respiratory failure, based on the history of asthma, a “silent chest,” and the arterial blood gas results.

CONCLUSION

A posterior fossa meningioma of such a large size and with extensive infiltration rarely presents with an isolated unilateral vocal cord palsy. The patient’s chief presenting feature was severe respiratory distress, which combined with his background medical history of asthma, was misleading. Clinicians should thus consider meningioma as a differential diagnosis for a unilateral vocal cord palsy even without audiology involvement.

Keywords: Respiratory distress; Meningioma; Unilateral vocal cord palsy; Posterior fossa tumour; Neurosurgery; Neurology; Radiology; Case report

Core Tip: This case report described an atypical presentation for a posterior fossa tumour. Initially, the patient was assessed as severe respiratory distress after a background history of asthma. However, after further investigation and management the patient had an upper airway obstruction secondary to a unilateral vocal cord palsy. This was found to be a complication of a cerebellar-pontine tumour. Upon further research, no cases have been presented recently where a patient had unilateral vocal cord palsy subsequent to the tumour. This presentation may be explained secondary to the effacement and displacement of the surrounding structures from the tumour.