Complex, though highly interpretable, clinical presentation!

A 54-year-old previously healthy man was referred to the neurologist because of an insidious onset of hoarseness of voice, dysphagia with frequent choking and nasal regurgitation.

Examination revealed:

•  Weakness of the left sternomastoid muscle
•  Flattening of the left shoulder
•  Wasting of the tungue (which deviates to the left when protruded)
•  Left side Horner’s syndrome
•  Gag reflex was absent on the left

What's the diagnosis?




The diagnosis is Jugular Foramen Syndrome