Neurosarcoidosis Directly Involving the Cervical Vagus Nerve

Crossley, Jason R.; Aminpour, Nathan; Giurintano, Jonathan P.; Jay, Ann K.; Harris, Brent T.; Hoa, Michael

doi:10.1177/0003489420942546

Cited by 5 publications

(5 citation statements)

References 10 publications

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“…Lastly, as this report is a fully ChatGPT/NLP-generated case report, it can be compared against the original article, which serves as the benchmark for case report quality [ 5 ]. Various prompts used in the generation of this report can be seen in Figures 5 , 6 .…”

Section: Discussionmentioning

confidence: 99%

Bilateral Vocal Fold Paralysis in a Patient With Neurosarcoidosis: A ChatGPT-Driven Case Report Describing an Unusual Presentation

Guirguis¹,

Crossley²,

Malekzadeh³

2023

Cureus

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This ChatGPT-driven case report describes a unique presentation of neurosarcoidosis. The patient, a 58year-old female, initially presented with hoarseness and was found to have bilateral jugular foramen tumors and thoracic lymphadenopathy. Imaging revealed significant enlargement and thickening of the vagus nerve and a separate mass of the cervical sympathetic trunk. The patient was referred for an ultrasound-guided biopsy of the abnormal neck masses to establish a pathologic diagnosis. The patient subsequently underwent neck dissection for exposure of the vagus nerve and isolation of the great vessels in preparation for a transmastoid approach to the skull base. The presence of multifocal tumors prompted the need for a biopsy, which ultimately revealed sarcoid granulomas in the nervous system. The patient was diagnosed with neurosarcoidosis. This case highlights the potential for sarcoidosis to affect the nervous system, with multiple cranial nerve involvement, seizures, and cognitive impairment. It also emphasizes the need for a combination of clinical, radiological, and pathological findings for an accurate diagnosis of neurosarcoidosis. Additionally, this case highlights the utility of natural language processing (NLP), as the entire case report was written using ChatGPT. This report serves as a comparison of the quality of case reports generated by humans versus NLP algorithms. The original case report can be found in the references.

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Section: Discussionmentioning

confidence: 99%

Bilateral Vocal Fold Paralysis in a Patient With Neurosarcoidosis: A ChatGPT-Driven Case Report Describing an Unusual Presentation

Guirguis¹,

Crossley²,

Malekzadeh³

2023

Cureus

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“…The vagus nerve on the right in the mid-neck has been shown to have a larger diameter than the left vagus nerve (14,15). US measurements of the diameter of the vagus nerve have been studied in Parkinson's disease (6,16), bulbar atrophy (17), inflammatory polyneuropathies (7,18), and neurosarcoidosis (19). US guidance has been largely employed for neurostimulator placement in epilepsy (10,20) and has also recently been employed for microelectrode insertion into the vagus nerve for electrophysiologic microneurography (21).…”

Section: Discussionmentioning

confidence: 99%

Preoperative ultrasound mapping of the vagus nerve in thyroid surgery

Bidault¹,

Girard²,

Attard³

et al. 2022

Gland Surg

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Background: Intraoperative neuromonitoring (IONM) in thyroid surgery requires electric stimulation of the vagus nerve to verify correct electrode placement. Classically the nerve is found deep to or in-between the common carotid artery and internal jugular vein, but previous studies have shown that the nerve can sometimes be found superficial to the vessels. Our aim was to determine the incidence of a superficial vagus nerve using ultrasound (US) and study possible clinical factors associated with an anteriorly-located vagus nerve.Methods: Retrospective study of patients undergoing thyroid surgery (lobectomy or total thyroidectomy) with intermittent IONM. Substernal goiters, locally invasive tumors or bulky lymph nodes were excluded.The vagus nerve was identified at the level of the mid-thyroid lobe on each side on preoperative US performed by two specialized radiologists, and its location according to 6 possible positions in relationship to the common carotid artery was recorded. The anatomic variability of the vagus nerve was analyzed in relationship to patient demographics and thyroid pathology.Results: Five-hundred twenty-seven patients were included. The right vagus nerve (n=522) was in-between, superficial or deep to the vessels in 92.3%, 6.1% and 1.5% and of cases, respectively, and the left vagus (n=517) in 80.2%, 18.6% and 1.2% of cases, respectively, with a statistically significant difference between right and left vagus nerves (P<0.001). The type of pathology, size of the dominant nodule or the volume of the thyroid lobe were not correlated to finding a superficial vagus nerve. Conclusions:The vagus nerve was identified in all cases on US and found to be anterior to common carotid artery at the level of the thyroid lobe in 18.6% of cases on the left and 6.1% of cases on the right.Identifying this anatomic variant preoperatively may facilitate IONM and avoid inadvertent trauma to the vagus nerve during thyroid surgery.

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“…(Table 1) right-sided vocal fold paralysis have been reported [3,15]. Bilateral vocal fold immobility has been reported in eight cases, four of them were due to central cause [16][17][18].…”

Section: Literature Reviewmentioning

confidence: 95%

“…Reports of unilateral left vocal cord palsy are more common probably due to compression by the bulky mediastinal nodes on the left recurrent laryngeal nerve at the level of the arch of the aorta. Mechanisms of nerve palsy not fully understood till today, however the common etiology found in literature is compressive mediastinal lymphadenopathy, direct laryngeal involvement and cranial polyneuritis [16,17]. Most of the theories come around local compression mechanisms.…”

Section: Literature Reviewmentioning

confidence: 99%