From Syncope to Stroke: Vascular Complications of Skull Base Paraganglioma.

Background: Head and neck paragangliomas are typically slow-growing neuroendocrine tumours, but their proximity to major cervical vessels can result in significant neurovascular complications. Ischemic stroke is rarely described as a direct consequence and is more commonly attributed to catecholamine-mediated hypertension or vasospasm. Case description: A 48-year-old woman presented with recurrent syncope and was found to have multifocal acute ischemic infarcts on magnetic resonance imaging of the brain. Imaging revealed recurrent jugular foramen paraganglioma with extension along the internal carotid artery and compression of the internal jugular vein. The infarct pattern was embolic in distribution. Although hypertension and recent cocaine use were present, the close anatomic relationship between the tumour and major cervical vessels suggested tumour-related vascular compromise with secondary thromboembolism as a primary mechanism. Conclusion: This case highlights structural vascular involvement by head and neck paraganglioma as an underrecognized cause of embolic stroke. In patients with skull base tumours and multifocal infarcts, direct tumour-related vascular compromise should be considered to guide appropriate multidisciplinary management and reduce the risk of recurrent events. LEARNING POINTS: Head and neck paragangliomas can cause ischemic stroke through direct vascular involvement, including carotid artery encasement and jugular vein compression, creating a structural source of thromboembolism.Multifocal infarcts across multiple vascular territories should prompt evaluation for embolic and structural causes, even in the presence of traditional risk factors such as hypertension or cocaine use.