Isolated unilateral hypoglossal nerve paralysis caused by an atlanto-occipital joint synovial cyst

Mujic, Asim; Hunn, Awm; Liddell, Jeffrey R.; Taylor, Bvm; Havlat, Marek; Beasley, T. Mark

doi:10.1016/s0967-5868(03)00083-3

Cited by 28 publications

(31 citation statements)

References 7 publications

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“…There are 3 reported intraneural cases. 5,12,25 Seven extraneural cases have been documented, 11,[13][14][15]19,22,28 5 derived from the atlantooccipital joint 11,13,14,22,28 and 2 from the atlantoaxial joint. 15,19 There is some controversy about whether the 3 mentioned "intraneural" cases are in fact intra-or extraneural and whether joint connections existed in these cases.…”

Section: Discussionmentioning

confidence: 99%

An inferior alveolar intraneural cyst: a case example and an anatomical explanation to support the articular theory within cranial nerves

Capek¹,

Koutlas

Strasia

et al. 2015

JNS

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abbreviatioNs MIP = maximum intensity projection; TMJ = temporomandibular joint. submitted April 9, 2014. accepted December 10, 2014. iNclude wheN citiNg Published online February 6, 2015; DOI: 10.3171/2014.12.JNS14798. disclosure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. The authors describe the case of an intraneural ganglion cyst involving a cranial nerve (V3), which was found to have a joint connection in support of an articular origin within the cranial nerves. An inferior alveolar intraneural cyst was incidentally discovered on a plain radiograph prior to edentulation. It was resected from within the mandibular canal with no joint connection perceived at surgery. Histologically, the cyst was confirmed to be an intraneural ganglion cyst. Reinterpretation of the preoperative CT scan showed the cyst arising from the temporomandibular joint. This case is consistent with the articular (synovial) theory of intraneural ganglion cysts. An anatomical explanation and potential joint connection are provided for this case as well as several other cases of intraneural cysts in the literature, and thus unifying cranial nerve involvement with accepted concepts of intraneural ganglion cyst formation and propagation.

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Section: Discussionmentioning

confidence: 99%

An inferior alveolar intraneural cyst: a case example and an anatomical explanation to support the articular theory within cranial nerves

Capek¹,

Koutlas

Strasia

et al. 2015

JNS

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“…Isolated hypoglossal nerve palsy is quite rare and represents a diagnostic challenge in everyday clinical practice. It has been associated with various pathologies such as hypoglossal nerve schwannomas, dural arteriovenous fistulas, enlarged emissary veins of the hypoglossal canal, aneurysms of the stump of a persistent hypoglossal artery, occipital condyle fractures, arachnoid cysts, juxta facet synovial cyst, metastatic lesions to the skull base, internal carotid and vertebral artery dissections, cervical rheumatoid arthritis and Arnold-Chiari malformation [5][6][7] . In certain cases, no apparent cause was found.…”

Section: Discussionmentioning

confidence: 99%

An Unusual Case of Isolated Hypoglossal Nerve Palsy Secondary to Osteophytic Projection from the Atlanto-Occipital Joint

2014

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“…Isolated hypoglossal neuropathy has also been reported in association with synovial cysts arising from the atlanto-occipital joint 5 or atlanto-axial joint, 6 in the absence of neck trauma. Surgical fixation of the cervical spine, through an anterior or posterior approach, can also be associated with hypoglossal nerve injury.…”

Section: Practical Implicationsmentioning

confidence: 99%

A tardy tongue palsy

et al. 2016

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A 76-year-old man presented with insidious onset of slurred speech and difficulty swallowing over 1 year. Initial symptoms were episodic imprecise articulation, tongue swelling, tongue deviation, and mild right-sided headache. Progressive deterioration of speech and swallowing function had occurred; at the time of presentation, the patient was struggling to swallow food and saliva. He had undergone C1-C5 posterior fusion following a C2 fracture 50 years prior. There was no relevant medical history and the patient was systemically well. Examination found hemiatrophy of the right side of the tongue with visible fasciculations. The tongue protruded to the right and there was associated dysarthria. There was no evidence of other cranial nerve involvement, cervical myelopathy, or a diffuse motor neuron disorder.Imaging of the head found evidence of right atlanto-occipital arthritis with an osteophyte impinging upon the right exiting hypoglossal nerve at the hypoglossal canal. The right genioglossus was denervated and atrophic (figure). Vascular imaging excluded dissection of cervical or intracranial vessels. Needle EMG of the tongue found fibrillations and small, polyphasic varying motor units with markedly reduced recruitment in the right genioglossus, suggesting active denervation and reinnervation. EMG of left genioglossus and upper and lower limbs was unremarkable.Extension of the cervical fusion was considered, but the patient elected to pursue conservative treatment and underwent a course of speech therapy. DISCUSSIONThe twelfth cranial nerve is a pure motor nerve primarily responsible for innervation of the intrinsic and extrinsic muscles of the tongue. Nerve injury causes speech and swallowing dysfunction, ipsilateral tongue paresis, and deviation to the side of the lesion. Hypoglossal nerve lesions are rare and result from diverse etiologies, most commonly benign or malignant tumors, trauma, stroke, vascular dissection, brainstem demyelination, infection, and iatrogenic injury. 1In this case, the hypoglossal neuropathy most likely resulted from mechanical compromise of the nerve by an osteophyte arising from the right atlanto-occipital joint. There is heterotopic ossification outside of the hypoglossal canal; therefore direct nerve impingement is likely responsible for ongoing denervation. Arthritis of this joint typically presents with unilateral unremitting occipital-cervical pain exacerbated by neck movement and neurologic complications are rare. However, dynamic motion between the occipital cervical junction may also contribute to nerve injury. The history of trauma is relevant, since post-traumatic arthritis of the joint, or arthritis secondary to cervical spine fixation (i.e., adjacent segment disease), may be contributory. The long delay between the original neck injury and the onset of tongue weakness Practical ImplicationsHypoglossal neuropathy is a rare complication of neck trauma and degenerative spine disease. Atlanto-occipital arthritis should be considered as a possible cause for isolated hypog...

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Isolated unilateral hypoglossal nerve paralysis caused by an atlanto-occipital joint synovial cyst

Cited by 28 publications

References 7 publications

An inferior alveolar intraneural cyst: a case example and an anatomical explanation to support the articular theory within cranial nerves

An inferior alveolar intraneural cyst: a case example and an anatomical explanation to support the articular theory within cranial nerves

An Unusual Case of Isolated Hypoglossal Nerve Palsy Secondary to Osteophytic Projection from the Atlanto-Occipital Joint

A tardy tongue palsy

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