Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 6, 2024; 12(13): 2281-2285
Published online May 6, 2024. doi: 10.12998/wjcc.v12.i13.2281
Atypical presentation of a posterior fossa tumour: A case report
Alisha Narotam, Mikara Archary, Poobalan Naidoo, Yeshkhir Naidoo, Vanesha Naidu
Alisha Narotam, Mikara Archary, Department of Internal Medicine, King Edward VIII Hospital - University of Kwazulu-Natal, Durban 4001, Kwa-Zulu Natal, South Africa
Poobalan Naidoo, Department of Internal Medicine, Nelson R Mandela, School of Medicine, University of Kwa-Zulu Natal, Durban 4001, Kwa-Zulu Natal, South Africa
Yeshkhir Naidoo, Vanesha Naidu, Department of Radiology, King Edward VIII Hospital - University of Kwazulu-Natal, Durban 4001, Kwazulu-Natal, South Africa
Author contributions: Narotam A was the corresponding author and submitted the manuscript; Archary M, Narotam A, and Naidoo P wrote, edited, and reviewed the manuscript; Naidoo Y and Naidu V analysed and reported the radiological images.
Informed consent statement: Written informed consent was obtained from the patient.
Conflict-of-interest statement: All the authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Alisha Narotam, MBChB, Doctor, Department of Internal Medicine, King Edward VIII Hospital - University of Kwazulu-Natal, 719 Umbilo Road Umbilo, Durban 4001, Kwa-Zulu Natal, South Africa. alisha296@gmail.com
Received: January 5, 2024
Peer-review started: January 5, 2024
First decision: January 30, 2024
Revised: February 19, 2024
Accepted: March 21, 2024
Article in press: March 21, 2024
Published online: May 6, 2024
Processing time: 110 Days and 18.8 Hours
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.