Introduction: The jugular foramen (Vernet) syndrome with neuropathy of cranial nerves IX-XI is more commonly due to metastatic lesions than primary neoplasms. Hypoglossal nerve involvement is referred to as the Collet Sicard variant of the jugular foramen syndrome. Materials and Methods: We report an elderly man who presents with dysphagia, dysarthira, hoarseness, and a 12-pound weight loss. Examination demonstrated paralysis of the right vagus and hypoglossal nerve. Communication and collaboration with the radiologist resulted in identification of the lesion. Computed tomographic (CT) guided needle aspiration confirmed metastatic melanoma. Discussion: The onset of cranial neuropathy may allow the site of lesion to be predicted based on knowledge of the cranial base and neural anatomy. Diagnostic evaluation is tailored to evaluate the area in question. Active, multidisciplinary collaboration is assential for success.
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