Ross Hauser, MD.
Jugular foramen syndrome has traditionally been described as a condition caused by tumors, fractures, infections, or inflammatory disorders affecting the structures that pass through the jugular foramen at the base of the skull. These structures include the glossopharyngeal (IX), vagus (X), and spinal accessory (XI) cranial nerves, as well as the beginning of the internal jugular vein. While these remain the classic causes, we have seen patients where cervical spine instability become the leading suspect in the patient’s symptoms.
The symptoms of jugular foramen dysfunction depend on which of the lower cranial nerves are affected.
When the vagus nerve (cranial nerve X) is involved, patients may experience hoarseness or a weak, breathy voice, difficulty swallowing (dysphagia), choking or coughing when drinking liquids, and weakness of the soft palate that may cause the uvula to deviate toward the unaffected side.
Involvement of the glossopharyngeal nerve (cranial nerve IX) can lead to loss of taste and sensation over the posterior one-third of the tongue, a diminished or absent gag reflex on the affected side, and reduced salivary gland function.
If the spinal accessory nerve (cranial nerve XI) is affected, patients may develop weakness of the sternocleidomastoid and trapezius muscles, resulting in shoulder drooping, difficulty shrugging the shoulder, and weakness when turning the head away from the affected side.
Because the glossopharyngeal, vagus, and spinal accessory nerves all exit the skull through the jugular foramen, pathology affecting this region may produce symptoms involving one, two, or all three nerves. The specific pattern of neurological deficits often helps localize the site of injury and identify the underlying cause.
Over the years, we have evaluated many patients with persistent neurological symptoms that could not be fully explained by conventional imaging or neurological testing. This has led us to investigate whether craniocervical instability (CCI) may create a dynamic form of jugular foramen dysfunction. Rather than a tumor or other fixed lesion compressing the nerves, excessive motion between the skull, atlas (C1), and axis (C2) may intermittently stretch or compress the lower cranial nerves and surrounding vascular structures.
We have published opinions in the medical literature (1, 2) where we sought to explain why some patients experience symptoms such as difficulty swallowing, hoarseness, chronic cough, headaches, dizziness, tinnitus, brain fog, palpitations, and other signs of autonomic dysfunction. If the vagus nerve, internal jugular vein, or neighboring structures are mechanically affected by abnormal cervical motion, the resulting symptoms can extend well beyond the classic description of jugular foramen syndrome.
In our 2026 Frontiers in Neurology study, we retrospectively evaluated 227 patients with persistent neurological symptoms. We found radiographic evidence of C1-C2 ligamentous instability in 87% of patients, narrowing of the internal jugular veins in 98%, reduced vagus nerve cross-sectional area in 95%, and enlarged optic nerve sheath diameters in 99%. These findings demonstrate an association between cervical structural abnormalities and objective imaging findings.
We do not believe every patient with jugular foramen syndrome has cervical instability, nor do I believe cervical instability explains every case of lower cranial nerve dysfunction. However, in carefully selected patients, abnormal motion at the craniocervical junction may contribute to symptoms by affecting the lower cranial nerves, the internal jugular vein, and the autonomic nervous system.
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1 Hauser RA, Griffiths M, Watterson A, Matias D, Steilen C, Rawlings BR. Brain-based symptoms reported in young adults evaluated for cervical spine etiology: a retrospective, cross-sectional clinical study with preliminary data on over 200 patients. Frontiers in Neurology. 2026 May 25;17:1749266. [Google Scholar]
2 Hauser RA, Griffiths M, Watterson A, Matias D, Rawlings B. Objective test findings in patients with chronic eye symptoms seeking care at an outpatient neck center: ligamentous cervical instability etiology?. Frontiers in Neurology. 2025 Sep 22;16:1576315. [Google Scholar]