MRCP2-3096

MRCP2-3096

A 50-year-old woman presented with a 6-month history of difficulty in swallowing. She had been well until 20 months ago when she noticed she could not hear as well in her left ear. Shortly after this, she noticed she could hear her heart beating loudly in her left ear. These problems had continued over the last year and a half but in the last 6 months she had also noticed problems in swallowing, particularly liquids. Her husband had commented that over the same time period her voice was much hoarser than it had been previously.

On examination she had a hoarse voice, wasting of the sternocleidomastoid and trapezius on the left and a decreased gag reflex. Rinne’s test showed AC > BC on the right and BC > AC on left (AC = air conduction, BC = bone conduction); Weber’s test lateralised to the left ear. The remainder of the neurological examination was normal.

What is the most likely diagnosis?