LAUSR

A 27-year old woman with no major past medical history was referred to our neurological clinic for further evaluation of intractable and disabling coughing that she had progressively developed since several months. She described her cough as irritative, worsening during temperature changes, when lying down, and when eating and swallowing (‘allotussia’). Despite an extensive pneumological, otorhinolaryngologic, gastro-enterological, and cardiac work-up, no obvious cause of her cough was found. No effect was reported of various inhalers, antihistaminic drugs, proton pump inhibitors, or opioids. Gabapentin significantly improved her symptoms, but was discontinued by the patient because of weight gain. Clinical neurological examination showed no abnormalities. Being aware of the possibility of a brainstem lesion causing cough [1], brain MRI (Fig. 1) was performed. This showed a small, slightly enhancing nodule, located in the bottom of the fourth ventricle, in contact with the medulla oblongata, without mass effect or hydrocephalus-prompting consideration of subependymoma or plexus papilloma. Being a tumour, this lesion was removed surgically with the aim of possibly ameliorating the patients’ cough. The operation was uneventful, and there was no clear brainstem contact. Pathological examination revealed a WHO 2016 grade 1 choroid plexus papilloma (Fig. 2). Post-operatively, the patient’s cough immediately and entirely disappeared. Several months later, however, her coughing progressively reappeared, with uneventful repeat imaging (not shown). Given the low WHO tumour grade and complete perioperative visual and post-operative pathological resection, disease recurrence was deemed unlikely.