VANCOUVER syndrome

Vagus Associated Neurogenic Cough Occurring due to Unilateral Vascular Encroachment of its Root.

Our team has recently successfully operated on the first case in the world where a neurogenic cough was cured by a unilateral decompression of the vagus nerve (MVD surgery).

We hope this new syndrome will become known as Vagus Associated Neurogenic Cough Occurring due to Unilateral Vascular Encroachment of the Root. This acronym, VANCOUVER syndrome, is an homage to the city where this discovery was made.

Here is a link to our recently published paper in the Journal of Otology, Rhinology & Laryngology.

Diagnosis

We are studying additional patients in order to present our recommended protocol for the diagnosis and treatment of this new condition. Neurogenic cough is a chronic cough caused by changes in the nerves of the throat. It is not caused by the usual causes of chronic cough such as gastric reflux, asthma, eosinophilic bronchitis, post-nasal drip, rhinosinusitis, or medications. Some cases are due to nerve damage or hypersensitivity following a viral ilness. Some, however, have no obvious cause. These are the cases we are interested in.

Patients with VANCOUVER syndrome describe an intermittent tickle deep in their throat. The sensation triggers an irresistible cough. The symptoms can get better with anti-neuralgia medications – the same medications that would help trigeminal neuralgia (e.g. carbamazepine, gabapentin). We have been studying this condition to decide what the ideal test will be to confirm the diagnosis. There could be a lot of people with neurogenic cough that do not have VANCOUVER syndrome and we want to be sure we do not operate on them. Over the last two years we tried a variety of tests and believe the appropriate diagnostic tests are as follows:

Inhaled nebulized lidocaine should stop the tickling sensation and hence stop the urge to cough for the duration of the anesthetic. If that works, then we proceed to determine if the effect is only one-sided. Patients have a unilateral vagus nerve block (utrasound guided in the neck). If the patient’s voice becomes hoarse then the vagus nerve has been blocked and the tickling sensation and coughing should stop. When the voice returns to normal as the anesthetic wears off, the coughing should return. A week later, the patient returns to have the other side done – this should have no benefit on the cough because VANCOUVER syndrome is one sided. If the side of the effective vagus nerve block is also the side that the MRI shows a vessels against the vagus nerve, then MVD surgery can be discussed.

Billy Reid statue at Museum of Anthropology

Bill Reid’s statue at Museum of Anthropology

The Haida artist, Bill Reid, carved The Raven and the First Men and it is on display at the Museum of Anthropology in Vancouver. It depicts the Haida’s interpretation of human creation. I believe this statue is also symbolic of the birth of VANCOUVER syndrome. A condition that has been around a long time but unrecognized by the rest of the world until recently.