A 54 year old female on evaluation of dysarthria was found to have left IX, X and XII cranial nerve palsy. General physical examination revealed bilateral cervical level V multiple lymph nodes which were firm to hard and non-tender; respiratory system examination suggested left sided mild pleural effusion. MRI brain and cervical spine did not show any evidence of meningeal enhancement or skull base metastasis. Bronchoscopy revealed a mass lesion in left main bronchus. Her cranial nerve symptoms were attribu…