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Multiple paralysis of the cranial nerves secondary to tuberculosis is rare. We herein report the case of a patient with tuberculous cervical lymphadenitis who presented with unilateral paralysis of the 9th, 10th and 11th cranial nerves and hypertrophy of dura mater with diagnostic challenges. The patient was a 62 year-old female who visited us with dysphagia and hoarseness of a few weeks in duration. A physical examination and laryngopharyngeal fiberscopy revealed the paralysis of the patient’s right vocal cord, soft palate and the trapezius muscle, while all of the laboratory and imaging examinations initially showed unremarkable results. PET and repeated head MRI scans were conducted two months later because of the patient’s severe weight loss, fatigue and headache. The PET scan showed the abnormal uptake of FDG in the right jugular foramen and both of the upper cervical nodes. MRI showed dural hypertrophy in the left cerebellar tentorium. Cervical lymph node biopsy was performed to search for possible malignancies. Based on the biopsy results, the patient was diagnosed with tuberculosis with the absence of lung lesions. The patient’s multiple nerve palsy, headache, and dural hypertrophy improved after six months of antituberculosis therapy. Thus, the patient’s jugular foramen syndrome and hypertrophic pachymeningitis were diagnosed as secondary symptoms of tuberculosis. Tuberculosis is one of the differential diagnoses that should be considered in patients with multiple cranial neuropathies with few clinical findings.

A Case of Tuberculous Jugular Foramen Syndrome and Hypertrophic Pachymeningitis