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AJNR Am J Neuroradiol. 2018 Oct 25. doi: 10.3174/ajnr.A5851. [Epub ahead of print]

Imaging and Surgical Findings in Patients with Hemi-Laryngopharyngeal Spasm and the Potential Role of MRI in the Diagnostic Work-Up.

Author information

1
From the Department of Surgery (J.A.-C., C.R.H.), Division of Neurosurgery.
2
Department of Radiology (M.G.K., J.R.S., M.K.S.H.), University of British Columbia, Vancouver, British Columbia, Canada.
3
From the Department of Surgery (J.A.-C., C.R.H.), Division of Neurosurgery chris.honey@telus.net.
4
Vancouver General Hospital (C.R.H.), Vancouver, British Columbia, Canada.

Abstract

BACKGROUND AND PURPOSE:

Hemi-laryngopharyngeal spasm is a recently discovered condition characterized by episodic coughing and unilateral throat contractions that may lead to severe stridor. These symptoms are caused by a vascular compression of the ipsilateral vagus nerve, typically the PICA. Microvascular decompression of the vagus nerve has been demonstrated to be a potential cure for this neurovascular compression syndrome. The main aim of this study was to clarify the role of MR imaging in the diagnostic work-up of this rare condition.

MATERIALS AND METHODS:

We describe the imaging and surgical findings of 3 patients from our prospective case series of patients with hemi-laryngopharyngeal spasm from 2015 to 2017. Second, the imaging data of 100 patients (control cohort) with symptoms unrelated to hemi-laryngopharyngeal spasm were reviewed to investigate the rate and degree of neurovascular conflict of the vagus nerve.

RESULTS:

All patients with hemi-laryngopharyngeal spasm reported to date have had vascular compression of the vagus nerve due to the PICA. In the control cohort, there was a good interrater agreement in scoring the "contact" and "compression" of the vagus nerve (κ = 0.73. P = < .001). The frequency of contact or compression of the vagus nerve was approximately 50%. The PICA was the most frequent vessel involved in 74%.

CONCLUSIONS:

The presence of unilateral neurovascular contact or compression of the vagus nerve does not confirm the diagnosis of hemi-laryngopharyngeal spasm. The MR imaging finding of ipsilateral vascular compression of the vagus nerve is a necessary but not sufficient finding for the diagnosis of hemi-laryngopharyngeal spasm.

PMID:
30361431
DOI:
10.3174/ajnr.A5851

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