Tuberculosis masquerading as isolated hypoglossal nerve palsy: A rare presenting scenario

Jena, Subhransu Sekhar; Mohapatra, Satya; Mohapatra, Debahuti; Mahanta, Seemanchana

doi:10.4103/0028-3886.227271

Cited by 3 publications

(15 citation statements)

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“…In our literature review, we found only 6 case reports of isolated HNP as a presentation of TB: Richards et al 8 in 1989; Chakraborty et al 9 in 2009; and the recent ones by Ebadi et al 7 in 2012, Jena et al 10 in 2018, and 2 cases by Pandey et al 11 in 2019 (Table I). In all these reports, involvement of CVJ by TB caused isolated unilateral HNP 7-11 . Three cases showed complete resolution of the deviation of the tongue 7,9,10 .…”

Section: Discussionmentioning

confidence: 88%

“…In our literature review, we found only 6 case reports of isolated HNP as a presentation of TB: Richards et al 8 I). In all these reports, involvement of CVJ by TB caused isolated unilateral HNP [7][8][9][10][11] . Three cases showed complete resolution of the deviation of the tongue 7,9,10 .…”

Section: Discussionmentioning

confidence: 99%

“…In all these reports, involvement of CVJ by TB caused isolated unilateral HNP [7][8][9][10][11] . Three cases showed complete resolution of the deviation of the tongue 7,9,10 . The tongue deviation persisted in 2 cases even after complete treatment with ATTand resolution of other symptoms 11 .…”

Section: Discussionmentioning

confidence: 99%

“…Unilateral HNP has diverse etiologies such as nasopharyngeal carcinoma, skull base metastasis, trauma, meningitis, HIV, and rarely dissection of the internal carotid artery 5,16,17 . However, isolated HNP as the only neurological finding is very rare and is limited to only few case reports [7][8][9][10][11] and case series 6,[16][17][18] .…”

Section: Discussionmentioning

confidence: 99%

“…Hypoglossal nerve palsy (HNP) may present with other neurological findings, but delayed and isolated involvement of the hypoglossal nerve is very rare. A few case reports or case series 6 have been reported with isolated HNP in CVJ TB [7][8][9][10][11] , but none as delayed palsy in a patient already on conservative management in the form of antitubercular treatment (ATT) and immobilization in a halo vest. We report a patient with TB of the CVJ who presented with delayed unilateral HNP after 3 months of conservative management as the only neurological manifestation of the disease.…”

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confidence: 99%

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Delayed Hypoglossal Nerve Palsy After Halo-Vest Immobilization in a Patient With C1-C2 Tuberculosis

Basu¹,

Gohil²

2022

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Case: A 48-year-old man presented with neck pain and torticollis without any neurodeficit. He was diagnosed with C1-C2 tuberculosis with left C1-C2 joint destruction and was immobilized with a halo vest and started on antitubercular treatment (ATT). At the 3-month follow-up, he presented with left hypoglossal nerve palsy (HNP). He responded to ATT with complete healing of C1-C2 lesion and good correction of deformity but persistent left-sided tongue deviation at the 2-year follow-up. Conclusion:HNP may occur as a complication of conservative management of craniovertebral junction tuberculosis (CVJ TB). Careful neurological assessment and monitoring must be performed while correcting deformities in CVJ TB using halovest immobilization.The manuscript has been read and approved by all the authors, the requirements for authorship have been met, and each author believes the manuscript represents honest work.Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/B900).

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Delayed Hypoglossal Nerve Palsy After Halo-Vest Immobilization in a Patient With C1-C2 Tuberculosis

Basu¹,

Gohil²

2022

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A case of extra pulmonary tuberculosis misdiagnosed as granulomatosis with polyangitis: Presenting with occipital condylar syndrome

Darshani

Sathischandra

Perera

2020

Indian Journal of Tuberculosis

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Unmasking the common thief: A rare cause of isolated hypoglossal nerve palsy

Khader,

Sivasubramanian,

Ravikumar

et al. 2023

Journal of Community Hospital Internal Medicine Perspectives

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Multiple cranial nerve palsies frequently accompany hypoglossal nerve palsy, potentially indicating malignancy, such as lymphoma, nasopharyngeal carcinoma, or metastases. However, when solely the hypoglossal nerve is affected, the causes may involve Chiari malformation, arachnoid cyst, or infectious mononucleosis, suggesting a positive prognosis. Craniocervical junction tuberculosis (TB), is an uncommon cause of isolated hypoglossal nerve palsy and has been reported infrequently in the literature. Craniocervical junction tuberculosis accounts for only 0.5% of TB cases overall and 6% of extra-pulmonary TB cases. We present here one such case of a 17-year-old male of Indian origin with a subacute history of tongue deviation and neck pain. Additionally, the patient reported loss of weight and appetite. The patient had significant posterior cervical lymphadenopathy. Neurological examination revealed findings suggestive of right peripheral hypoglossal nerve involvement. Blood investigations showed lymphocytosis along with an elevated erythrocyte sedimentation rate of 45 mm/h and elevated lactate dehydrogenase levels of 325 U/L. Tuberculin skin testing was positive and sputum acid-fast staining confirmed acid-fast bacilli. Magnetic Resonance Imaging of the cervical spine revealed a soft tissue component in the prevertebral space measuring 3.5×4.8 cm with a right paraspinal component adjoining the hypoglossal canal with peripheral contrast enhancement. Histological findings on the lymph node showed granulomatous lymphadenitis, suggestive of tuberculosis. The patient was started on 4-drug anti-tubercular therapy consisting of Isoniazid, Rifampicin, Pyrazinamide, and Ethambutol for a period of 18 months. He was subsequently followed up for 6 months till the resolution of palsy. This case emphasizes the importance of thorough evaluation and a meticulous workup to identify the underlying cause of hypoglossal nerve palsy and the importance of considering tuberculosis as a potential cause of isolated hypoglossal nerve palsy in everyday practice.

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Tuberculosis masquerading as isolated hypoglossal nerve palsy: A rare presenting scenario

Cited by 3 publications

References 0 publications

Delayed Hypoglossal Nerve Palsy After Halo-Vest Immobilization in a Patient With C1-C2 Tuberculosis

Delayed Hypoglossal Nerve Palsy After Halo-Vest Immobilization in a Patient With C1-C2 Tuberculosis

A case of extra pulmonary tuberculosis misdiagnosed as granulomatosis with polyangitis: Presenting with occipital condylar syndrome

Unmasking the common thief: A rare cause of isolated hypoglossal nerve palsy

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