J Cerebrovasc Endovasc Neurosurg.  2022 Dec;24(4):386-392. 10.7461/jcen.2022.E2021.11.002.

Right cerebellar stroke with a right vertebral artery occlusion following an embolization of the right glomus tympanicum tumor: Case report with literature review

• Kajtazi NI
• Manzoor MU
• Ghamdi JA
• Zahrani HA
• Suwaidan FA
• Qahtani SA
• Bafaquh M

• KMID: 2537324
• DOI: http://doi.org/10.7461/jcen.2022.E2021.11.002

Abstract

A 35-year-old female presented with episodes of frequent dizziness, ear fullness, and right ear tinnitus for 12 months. Head imaging revealed a right glomus tympanicum tumor. She underwent pre-operative endovascular embolization of the glomus tympanicum tumor with surgical, cyanoacrylate-based glue. Immediately after the procedure, she developed drowsiness and severe pain in the right temporal region. Further investigations revealed a right cerebellar stroke in the posterior inferior cerebellar artery territory. She was treated with intravenous heparin, followed by one year of oral anticoagulation. With rehabilitation, she significantly recovered from her post embolization stroke. However, the tumor was resected at another institution. Ten years later, follow-up imaging indicated a gradual increase in the size of the glomus jugulare tumor compressing the nearby critical vascular structures. She subsequently received radiation therapy to treat the residual tumor. Currently, she has no neurological deficit, but her mild dizziness, right ear tinnitus, and hearing impairment persist.

Keyword

Glomus tympanicum tumor; Therapeutic embolization; Stroke; Vertebral artery occlusion

Figure

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  Fig. 1. Magnetic resonance imaging (MRI) Axial 3D brain volume (BRAVO) of temporal bone and internal auditory canal with contrast demonstrates a soft tissues signal intensity (curved white arrow) in the middle ear cavity of the right side with intense enhancement.

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  Fig. 2. Cerebral angiogram shows tumor blush (white circle) is at the expected area of the right middle ear cavity that is supplied by one of the branches of right ascending pharyngeal artery likely inferior tympanic artery.

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  Fig. 3. Cerebral angiogram, selective catheterization of the right ascending pharyngeal artery reaching nearly the tumor bed (white circle).

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  Fig. 4. Cerebral angiogram post embolization with 20% concentration of glubran without residual tumor blush (white circle).

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  Fig. 5. Computed tomography brain plain post embolization demonstrates glue material seen at the region of the right temporal bone (red arrow) with small reflux of glue material to the right vertebral artery (white arrowhead).

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  Fig. 6. Brain MRI post embolization shows acute right cerebellar stroke in the PICA distribution (straight white arrow). MRI, magnetic resonance imaging; PICA, posterior inferior cerebellar artery

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  Fig. 7. Brain magnetic resonance angiography shows complete occlusion of the right vertebral artery (curved white arrow) just before the basilar junction.

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  Fig. 8. Brain MRI (magnetic resonance imaging) with neuronavigation and contrast shows right glomus jugulare mass obstructing the flow along the right internal jugular vein (curved white arrow).

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