Disclosures: Alex Z. Schumaker, MD: No financial relationships or conflicts of interest

Case Diagnosis: 79-year-old male with past medical history significant for left-sided facial pain for several weeks with new onset visual disturbance in left eye with MRI evidence of left glomus jugulotympanic tumor (likely paraganglioma) as the primary cause of symptoms.

Case Description or Program Description: Patient underwent laparoscopic cholecystectomy and post-operative course was complicated by worsening of left-sided facial pain, intractable headache, and new onset blurry vision in left eye. Further associated symptoms included ocular pain, jaw claudication, and recent history of weight loss. Patient was medically stabilized and admitted to inpatient rehabilitation (IPR) unit without a clear diagnosis explaining above symptoms.

Setting: IPR unit within tertiary care hospital

Assessment/Results: Patient was initially started on high-dose steroids given concern for giant cell arteritis (GCA). Temporal artery biopsy was completed and negative for GCA. Treated with Topiramate without significant improvement of headache or facial pain. Extensive evaluation completed while patient was on the IPR unit with imaging that included MRI of brain, cervical spine, soft tissue of neck, and orbits. These studies demonstrated an enhancing lesion of the left occipital condyle with erosion of the osseous margins likely representative of a jugular fossa paraganglioma. Given patient’s medical co-morbidities, biopsy was deferred while inpatient for a definitive diagnosis. He was discharged from the IPR unit to the acute medical floor as he was ultimately unable to tolerate intensity of therapies given significant pain.

Discussion (relevance): Jugulotympanic paragangliomas are known to manifest in elderly patients with symptoms that may include vertigo, headache, hearing loss, or visual disturbance. Some of these are common symptoms in IPR patients.

Conclusions: Headaches are a common medical complaint for patients in the IPR unit. Jugulotympanic paragangliomas are rare, however, they can cause severe pain and debility in rehabilitation patients who develop one. It is important for physiatrists to keep a broad differential for appropriate diagnosis and for optimal symptom management.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/left-sided-facial-pain-and-visual-disturbance-secondary-to-jugulotympanic-paraganglioma-diagnosed-in-inpatient-rehabilitation-a-case-report/