Hyperactive rhizopathy of the vagus nerve and microvascular decompression - Case report

A 37-year-old woman underwent microvascular decompression of the superior v estibular nerve for disabling positional vertigo. Immediately following the operation, she noted severe and spontaneous gagging and dysphagia. Multipl e magnetic resonance images were obtained but failed to demonstrate a brain stem lesion and attempts at medical management failed. Two years later she underwent exploration of the posterior fossa. At the second operation, the vertebral artery as well as the posterior inferior cerebellar artery were n oted to be compressing the vagus nerve. The vessels were mobilized and held away from the nerve with Teflon felt. The patient's symptoms resolved imme diately after the second operation and she has remained symptom free. The a uthors hypothesize that at least one artery was shifted at the time of her first operation, or immediately thereafter, which resulted in vascular comp ression of the vagus nerve. To the authors' knowledge, this is the first re ported case of a hyperactive gagging response treated with microvascular de compression. The case also illustrates the occurrence of a possibly iatroge nic neurovascular compression syndrome.