Isolated Peripheral Hypoglossal Nerve Palsy Associated with Arterial Hypertension Caused by Neurovascular Compression

Abstract

We report a case of isolated left peripheral hypoglossal nerve palsy caused by neurovascular compression associated with essential arterial hypertension. MR and MR-angiography revealed an anomalous course of the left vertebral artery and left PICA. A similar case, without arterial hypertension, was reported by Rollnik et Al.According to Jannetta's hypothesis neurovascular compression of the brain stem may cause essential arterial hypertension. To our knowledge no other similar case of peripheral hypoglossal palsy and arterial hypertension caused by neurovascular compression has been reported.The possible role of neurovascular compression in the pathogenesis of essential hypertension is briefly discussed.Paralisi periferica isolata del nervo ipoglosso associata ad ipertensione arteriosa da conflitto neurovascolare RIASSUNTO-Gli autori riportano un caso di paralisi isolata delt'ipoglosso sinistro da compressione neurovascolare associata ad ipertensione arteriosa essenziale.Lo studio RM, ed angio-RM, ha evidenziato un anomalo decorso delt'arteria vertebrate sinistra e delta PICA omolaterale.Viene brevemente discusso it possibile ruolo delta compressione neurovascolare nelta patogenesi delt'ipertensione arteriosa essenziale.

Isolated, unilateral, reversible palsy of the hypoglossal nerve

“…Isolated peripheral hypoglossal nerve palsy is generally caused by primary or secondary tumours of the skull base (Albertini et al, 1996;Keane, 1996;Chong and Fan, 1998;Combarros et al, 1998;Fukumoto et al, 1998), trauma (Castling and Hicks, 1995;Kacker et al, 1995;Keane, 1996;Demisch et al, 1998), spontaneous or traumatic carotid artery dissection (Goodman et al, 1983;Dal Pozzo et al, 1989;Mokri et al, 1996;Pica et al, 1996), dural arteriovenous fistula (Blomquist et al, 1998;Combarros et al, 1998), Chiari malformation (Keane, 1996;Combarros et al, 1998), otorhinolaryngological and anaesthesiological procedures (Keane, 1996;Baumgarten et al, 1997), and rarely to kinking of the vertebral artery (Rollnik et al, 1996;Giuffrida et al, 1997;Morini et al, 1998). The hypoglossal nerve palsy is frequently irreversible; only a few cases of isolated hypoglossal palsy with complete recovery have been reported (De Simone and Snyder, 1978;Wright and Lee, 1980;Sugama et al, 1992;Barentini and Maurri, 1993;Keane, 1996;Combarros et al, 1998;Parano et al, 1998).…”

“…Hypoglossal palsy due to head trauma caused by a traction injury to the hypoglossal nerve at the base of the skull has a good prognosis, and it is often followed by a complete recovery (Kacker et al, 1995). We previously observed and reported in detail elsewhere two other cases of isolated unilateral hypoglossal nerve palsy; one of them, a young child affected by infectious mononucleosis had a complete recovery (Giuffrida et al, 1997;Parano et al, 1998). Considering our experience with isolated hypoglossal nerve palsy, and in agreement with other authors, we believe that the occurrence of benign and idiopathic isolated unilateral hypoglossal nerve palsy is more frequent than previously reported (Keane, 1996;Combarros et al, 1998).…”

“…A peripheral lesion of the XII cranial nerve causes ipsilateral tongue atrophy and deviation to the weak side when the tongue is protruded. Four different regions must be considered: nucleus and intramedullary filaments; cisternal; hypoglossal channel; and the extracranial part (Albertini et al, 1996;Keane, 1996;Rollnik et al, 1996;Giuffrida et al, 1997). Nuclear and intramedullary lesions usually involve adjacent nuclei or tracts, and more peripheral lesions generally involve other cranial nerves (Keane, 1996;Rollnik et al, 1996;Giuffrida et al, 1997;Combarros et al, 1998).…”

“…Four different regions must be considered: nucleus and intramedullary filaments; cisternal; hypoglossal channel; and the extracranial part (Albertini et al, 1996;Keane, 1996;Rollnik et al, 1996;Giuffrida et al, 1997). Nuclear and intramedullary lesions usually involve adjacent nuclei or tracts, and more peripheral lesions generally involve other cranial nerves (Keane, 1996;Rollnik et al, 1996;Giuffrida et al, 1997;Combarros et al, 1998). Isolated peripheral hypoglossal nerve palsy without involvement of other cranial nerves or long-tracts is a rare condition, while transient palsy without apparent cause is rarer (Barentini and Maurri, 1993;Keane, 1996;Omura et al, 1997;Combarros et al, 1998).…”