Síndrome de Villaret y adenocarcinoma de pulmón: una asociación infrecuente / Villaret syndrome and lung adenocarcinoma: an unusual association

El síndrome de Villaret se define por la afección de los nervios craneales glosofaríngeo (IX), vago (X), espinal (XI) e hipogloso mayor (XII), en conjunción con el síndrome de Horner homolateral a la lesión. Se produce por compresión de estos nervios y de las fibras vecinas del plexo simpático pericarotídeo en la base del cráneo, en particular, en el espacio retroparotídeo. Si bien es un hecho conocido la invasión del sistema nervioso central en el cáncer de pulmón avanzado, esta particular asociación sintomática es extremadamente infrecuente. Presentamos una paciente con diagnóstico reciente de adenocarcinoma de pulmón que desarrolló, en forma simultánea, este síndrome.

Villaret syndrome is defined by the affection of the glossopharyngeal (IX), vagal (X), accessory (XI) and hypoglossal (XII) cranial nerves associated with ipsilateral Horner syndrome. It is caused by the compression of these nerves and the neighboring sympathetic plexus fibers at the base of the skull, particularly in the retroparotid space. Even though the invasion of the central nervous system in patients with advanced lung cancer is a frequent and well known occurrence, this particular symptomatic association is extremely rare. We are reporting the case of a newly diagnosed lung adenocarcinoma patient who is simultaneously developing this syndrome.

Difficulty in Diagnosing a Case of Severe Headache Caused by Lung Cancer Metastasis to Base of Skull Due to Lack of Imaging Evidence

<p>Introduction: We report a case of severe headache caused by lung cancer metastasis to the base of the skull that was difficult to diagnose due to a lack of imaging evidence. Case: A 70-year-old man diagnosed with advanced lung cancer experienced sudden, severe headache. He was diagnosed as having a tension-type headache because magnetic resonance imaging of his head failed to detect any pathology. He was prescribed various drugs, which except for strong opioids failed to treat his headache. He referred to our palliative care unit to treat the pain. Re-evaluation of his head CT revealed metastasis to the clivas. His pain was treated with rapid titration of subcutaneous oxycodone injection. Conclusion: Even if radiographic investigations fail to identify the metastasis, the patient should be re-evaluated if the headache worsens and/or is accompanied with cranial nerve dysfunction.</p>