Teaching Video NeuroImages: Vagus nerve schwannoma: A trigger for cough.

A 40-year-old man presented with an insidious slowly enlarging nontender, firm, and movable mass on the right side of the neck for 3 years (figure 1). He had a 2-month history of paroxysmal cough and the cough could be elicited when the mass was palpated (video). MRI (figure 2) demonstrated that the mass involved the vagus nerve and displaced sternocleidomastoid muscle and the internal jugular vein laterally. The cough reflex is caused by stimulation of vagal nerve afferents.(1,2) Microscopic dissection showed the tumor was in the carotid sheath and arose from a single fascicle of the vagus nerve. The pathologic diagnosis was schwannoma. After the surgery, the patient had a normal voice, with no evidence of paroxysmal cough or recurrence.