The silent scream: Unraveling vagal nerve neuralgia; VANCOUVER syndrome and HeLPS

Erfan Shahabinejad; Amirreza Shakoeizadeh; Mina Jafari; Shayesteh Haghighi; Nima Rafati; Seyyed Mohammad Alipour; Mahla Esmaeili; Behina Salarian; Farid Abbaspour; Florian Roser; Abdulrahman Albakr; Hamid Borghei-Razavi

doi:10.1016/j.clineuro.2025.108909

The silent scream: Unraveling vagal nerve neuralgia; VANCOUVER syndrome and HeLPS

Clin Neurol Neurosurg. 2025 Jul:254:108909. doi: 10.1016/j.clineuro.2025.108909. Epub 2025 Apr 25.

Affiliations

¹ Student Research Committee, Rafsanjan University of Medical Sciences, Rafsanjan, Iran; USERN Office, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
² Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran.
³ Department of Nursing, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
⁴ Clinical Research Development Center, Najafabad branch, Islamic Azad University, Najafabad, Iran.
⁵ Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
⁶ Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran.
⁷ School of Medicine, Xi'an Jiaotong University, Xi'an, China.
⁸ Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.
⁹ Department of Neurosurgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE.
¹⁰ Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, Weston, FL, USA; Department of Surgery, Division of Neurosurgery, King Saud University, Riyadh, Saudi Arabia.
¹¹ Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, Weston, FL, USA; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Electronic address: borgheh2@ccf.org.

PMID: 40328139
DOI: 10.1016/j.clineuro.2025.108909

Abstract

Cranial nerves are mechanically irritated by vascular compression in neurovascular compression syndromes. Vagus nerve neuralgia is one of the less prevalent types of Neurovascular Compression Syndromes. It can cause disorders like Hemilaryngopharyngeal Spasm (HeLPS) and Vagus Associated Neurogenic Cough (VANCOUVER syndrome). HeLPS presents with unilateral spasms of the throat and coughing, whereas VANCOUVER syndrome is typified by a chronic cough brought on by vascular encroachment on the rootlet of the vagus nerve. The diseases' clinical manifestations, diagnosis, differential diagnoses, and therapy approaches are discussed, emphasizing the role of microvascular decompression (MVD) in the case of conservative treatment failure. Due to vagus nerve neuralgia's similarities to other diseases, including psychiatric conditions and gastroesophageal reflux disease (GERD), it can be difficult to diagnose and treat. To make the best possible treatment decisions, the effectiveness of both conservative and surgical care modalities including MVD and medication is discussed.

Keywords: HeLPS; Microvascular decompression; Neurovascular compression; VANCOUVER syndrome; Vagal Nerve Neuralgia.

Publication types

Review

MeSH terms

Cough* / diagnosis
Cough* / etiology
Hemifacial Spasm* / diagnosis
Hemifacial Spasm* / etiology
Humans
Microvascular Decompression Surgery / methods
Nerve Compression Syndromes* / diagnosis
Nerve Compression Syndromes* / surgery
Neuralgia* / diagnosis
Neuralgia* / surgery
Vagus Nerve / surgery
Vagus Nerve Diseases* / diagnosis
Vagus Nerve Diseases* / surgery
Vagus Nerve Diseases* / therapy