Is Hypoglossal Nerve Palsy Caused by Craniocervical Junction Degenerative Disease an Underrecognized Entity?

Weindling, Steven M.; Goff, Ryan; Wood, Chris; DeLone, David R.; Hoxworth, Joseph M.

doi:10.3174/ajnr.a4885

Cited by 10 publications

(10 citation statements)

References 23 publications

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“…Te third most common cause of isolated hypoglossal injury is internal carotid artery dissection. Cervical rheumatoid arthritis and cervical osteophytes from osteoarthritis have been more rarely implicated [5][6][7]. In children and adolescents, infectious mononucleosis should be investigated [2].…”

Section: Discussionmentioning

confidence: 99%

“…More modern case series are questioning if hypoglossal nerve palsy caused by craniocervical junction (CCJ) degenerative disease is an under-recognized entity because of provider unawareness compounded by difficulty in identifying the offending lesions on initial CT or MRI standard formats [ 7 ]. This was highlighted by our case.…”

Section: Discussionmentioning

confidence: 99%

“…Alerting the radiologist to one's suspicion of this diagnosis is critical so they can dedicate attention to the skull base and perform CT reconstructions if necessary. A retrospective series from the Mayo Clinic of 18 patients with hypoglossal nerve palsy from CCJ degenerative disease concluded that a small field of view; thin-section (≤2 mm) axial, coronal, and sagittal soft tissue; and bone reconstructions centered at the hypoglossal canal are more effective at identifying the offending CCJ degenerative disease [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

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Something Got Your Tongue? A Unique Cause of Hypoglossal Nerve Palsy

Tesson

Kranz

Zomorodi

et al. 2022

Case Reports in Neurological Medicine

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Introduction. The authors report a rare cause of isolated hypoglossal nerve palsy caused by a high cervical osteophyte. This case increases clinical knowledge of an underreported condition and teaches the clinician radiologic pearls in making the diagnosis. To their knowledge, this is the first case report showing surgical remediation of this condition. Symptoms and Clinical Findings. A 73-year-old female presented with several months of occipital headache, progressive dysarthria, dysphagia, and tongue deviation to the right. Her neurologic exam was significant for atrophy of the right hemitongue with tongue fasciculations. On protrusion, her tongue deviated rightward. Diagnosis and Therapeutic Intervention. Careful review of her initial head computed tomography (CT) imaging revealed that a high cervical osteophyte caused unilateral, isolated hypoglossal nerve palsy. Neurosurgery performed a right, far lateral approach for decompression of this osteophyte and over the ensuing months her symptoms improved. Conclusion. High cervical osteophyte is an underrecognized cause of isolated hypoglossal nerve palsy. The imaging investigation should be systematic and focus on the skull base with magnetic resonance imaging (MRI) or CT. This is a rare occasion when high resolution CT of the skull base can actually be the more helpful imaging modality. As shown in this case, an osteoarthritic cause can be surgically ameliorated.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Something Got Your Tongue? A Unique Cause of Hypoglossal Nerve Palsy

Tesson

Kranz

Zomorodi

et al. 2022

Case Reports in Neurological Medicine

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“…The etiologies of HNP in relation to spinal diseases can be categorized as follows: direct injury [11–14], indirect mechanical extension [13–19], insufficient circulation [20, 21], and inflammation [22, 23]; each occurs at the extracranial segment. First, direct injury to the spine has been shown to cause HNP.…”

Section: Discussionmentioning

confidence: 99%

Hypoglossal Nerve Palsy as a Cause of Severe Dysphagia along with the Oropharyngeal Stenosis due to Occipitocervical Kyphosis

Watanabe

Anno

Matsubayashi

et al. 2019

Case Reports in Orthopedics

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Hypoglossal nerve palsy (HNP) is a potential cause of dysphagia. A 66-year-old man presented to our hospital with dysphagia and neck pain. One year prior to his first visit, he had been diagnosed with upper cervical tuberculosis and had undergone posterior C1-2 fixation. The physical examination led to the diagnosis of dysphagia with HNP, and he had severe weight loss. Radiographic examination revealed that the O-C kyphosis had been exacerbated and that the deformity was likely the primary cause of HNP. To restore the swallowing function, O-C fusion surgery was performed. Postoperatively, the patient showed immediate improvement of dysphagia with gradual recovery of hypoglossal nerve function. In the last follow-up evaluation, swallowing function was confirmed with no signs of HNP. Our results indicate that HNP could be more prevalent in cases with severe cervical kyphosis, being underdiagnosed due to the more apparent signs of the oropharyngeal narrowing.

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“…Hypoglossal nerve palsy due to upper cervical degenerative disease has been reported, which further supports the above diagnosis. [14] However as hypoglossal nerve palsy secondary to degenerative cervical spine is rare, we sought another explanation.…”

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confidence: 99%

Cervical myeloradiculopathy with Hypoglossal Schwannoma mimicking Amyotrophic lateral sclerosis: a Case report

Ambawatte

Weerathunga

Dissanayake

et al. 2019

Preprint

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Background: A presentation of upper motor and lower motor clinical signs without sensory impairment may suggest Amyotrophic lateral sclerosis, especially when it involves limbs and bulbar regions. However, co-existence of two or more unrelated pathologies can give rise to a clinical picture similar to Amyotrophic lateral sclerosis. Case presentation: A 45 year old lady presented with slowly progressive right upper limb weakness for 6 months and mild left upper limb weakness for 2 months associated with muscle twitching. Her family members have noticed a change in character of her speech for few weeks. She couldn’t recall a radicular pain at any given time. On examination, her right deltoid was wasted with numerous fasciculations over right proximal muscles. Right shoulder movements were weak. Her left deltoid was slightly wasted and fasciculations were appreciated. Her both biceps and supinator jerks were normal with exaggerated triceps jerks and positive Hoffman sign. Sensory and proprioception examinations were unremarkable. Both lower limbs were hypertonic with exaggerated knee and ankle jerks. Ankle clonus was absent and plantar responses were equivocal. Her tongue was deviated to right side with fascicuations and wasting of right side. Palatal movements and Jaw jerk were normal. She was clinically diagnosed as possible amyotrophic lateral sclerosis. Electromyography showed denervation changes in deltoids and biceps with right predominance and right genioglossus muscle too showed denervation changes. Magnetic resonant imaging of brain stem was undertaken especially because her tongue wasting and fasciculations were unilateral and it showed a right sided hypoglossal schwannoma. Magnetic resonant imaging of cervical spine revealed degenerative disk disease with mild cord compression and exit foramina narrowing at multiple levels. Conclusions: Pure motor symptoms with a mixture of upper motor and lower motor signs may suggest a clinical diagnosis of Amyotrophic lateral sclerosis. However, when there are rare manifestations of a relatively common disease, such as unilateral tongue involvement as in the above scenario, a higher degree of clinical suspicion is needed to think of a dual pathology. Keywords: Hypoglossal schwannoma, cervical myeloradiculopathy, Amyotrophic lateral sclerosis, dual pathology.

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Is Hypoglossal Nerve Palsy Caused by Craniocervical Junction Degenerative Disease an Underrecognized Entity?

Cited by 10 publications

References 23 publications

Something Got Your Tongue? A Unique Cause of Hypoglossal Nerve Palsy

Something Got Your Tongue? A Unique Cause of Hypoglossal Nerve Palsy

Hypoglossal Nerve Palsy as a Cause of Severe Dysphagia along with the Oropharyngeal Stenosis due to Occipitocervical Kyphosis

Cervical myeloradiculopathy with Hypoglossal Schwannoma mimicking Amyotrophic lateral sclerosis: a Case report

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