PMC10330762_01
Illustration of the timeline of events, with reported complaints, diagnostic testing, and treatments is shown separately. CE, contrast-enhancing; CTA, computed tomography angiography EEG, electroencephalography; FEES, fiberoptic endoscopic evaluation of swallowing; Gy, gray; Ga-DOTA, gallium 68 labeled 1,4,7,10-tetraazacyclododecane-tetraacetic acid; MRI, magnetic resonance imaging; PET/CT, positron emission tomography/computed tomography; SSTR2, somatostatin receptor 2; TLOC, transient loss of consciousness.
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F1
TLOC for approximately 2 to 3 min was noticed at least four times per week (see Figure 1 for the timeline of events). These symptoms occurred independently of her head and body position, and she could not avoid her episodes of TLOC with typical prevention maneuvers for vasovagal syncope such as squatting and leg crossing.
Illustration of the vagal schwannoma on brain MRI (axial, sagittal, and coronal post-contrast T1 volumetric interpolated breath-hold examination (VIBE) sequences) before treatment (A-C) and on follow-up, 6 months after treatment (D-F). On initial imaging, a contrast-enhancing solid mass (marked with white arrows) in the right retrostyloid space in both the axial (A), sagittal (B), and coronal (C) plane can be seen. On follow-up, the solid mass is unchanged in size and morphology. Courtesy of MRI images (A-C): Bilddiagnostik Basel, Switzerland.
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F2
On magnetic resonance imaging (MRI) of the brain a homogenous, contrast-enhancing lesion in the retrostyloidal space suspicious of a vagal schwannoma (dimensions = 16 x 15 x 12 mm) was detected (Figures 2A-C). On repeated brain MRIs obtained in September 2022, the vagal schwannoma was unchanged in size and morphology (Figures 2D-F).