RESUMEN
BACKGROUND: Stroke is rarely accompanied with peripheral facial paralysis and supranuclear palsy of the hypoglossal nerve. Both sides of the motor cortex innervate the hypoglossal nucleus; therefore, unilateral lesions of the upper motor neurons rarely result in contralateral lingual paresis. We report a rare case of crossed syndrome with associated hyperacute peripheral hemifacial paralysis and contralateral lingual paresis after a lower pontine tegmentum ischemic stroke. CASE PRESENTATION: A 73-year-old man presented with symptoms of hyperacute peripheral hemifacial paralysis. Upon protrusion, the patient's tongue deviated to the contralateral side, without fasciculation or atrophy. Brain imaging showed focal ischemic stroke in the pontine tegmentum. However, lingual hemiparesis and multimodal neuroimaging findings differed. CONCLUSIONS: We suggest that cortico-hypoglossal fibers pass through the dorsal pontine. This case of crossed syndrome is a rare report of a lower pontine tegmentum ischemic stroke resembling an upper motor neuron lesion of the contralateral hypoglossal nerve.
Asunto(s)
Parálisis Facial , Enfermedades del Nervio Hipogloso , Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Masculino , Humanos , Anciano , Parálisis Facial/diagnóstico por imagen , Parálisis Facial/etiología , Parálisis , Paresia , Accidente Cerebrovascular/patología , Enfermedades del Nervio Hipogloso/complicaciones , Enfermedades del Nervio Hipogloso/diagnóstico por imagenRESUMEN
The hypoglossal nerve is the 12th cranial nerve, exiting the brainstem in the preolivary sulcus, passing through the premedullary cistern, and exiting the skull through the hypoglossal canal. This is a purely motor nerve, responsible for the innervation of all the intrinsic tongue muscles (superior longitudinal muscle, inferior longitudinal muscle, transverse muscle, and vertical muscle), 3 extrinsic tongue muscles (styloglossus, hyoglossus, and genioglossus), and the geniohyoid muscle. Magnetic resonance imaging (MRI) is the best imaging exam to evaluate patients with clinical signs of hypoglossal nerve palsy, and computed tomography may have a complementary role in the evaluation of bone lesions affecting the hypoglossal canal. A heavily T2-weighted sequence, such as fast imaging employing steady-state acquisition (FIESTA) or constructive interference steady state (CISS) is important to evaluate this nerve on MRI. There are multiple causes of hypoglossal nerve palsy, being neoplasia the most common cause, but vascular lesions, inflammatory diseases, infections, and trauma can also affect this nerve. The purpose of this article is to review the hypoglossal nerve anatomy, discuss the best imaging techniques to evaluate this nerve and demonstrate the imaging aspect of the main diseases that affect it.
Asunto(s)
Enfermedades del Nervio Hipogloso , Nervio Hipogloso , Humanos , Nervio Hipogloso/anatomía & histología , Nervio Hipogloso/patología , Enfermedades del Nervio Hipogloso/diagnóstico por imagen , Enfermedades del Nervio Hipogloso/patología , Lengua/inervación , Cabeza , Imagen por Resonancia MagnéticaAsunto(s)
Aneurisma , Enfermedades de las Arterias Carótidas , Enfermedades del Nervio Hipogloso , Enfermedades del Nervio Vago , Humanos , Nervio Hipogloso , Arteria Carótida Interna/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/complicaciones , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Parálisis , Nervio Vago , Enfermedades del Nervio Hipogloso/diagnóstico por imagen , Enfermedades del Nervio Hipogloso/etiologíaRESUMEN
This case report describes an 80-year-old patient's right-sided hemicranial headache, right-sided tongue hemiatrophy with fasciculations and deviation, right side of the tongue on protrusion, and mild dysarthria.
Asunto(s)
Pirofosfato de Calcio , Enfermedades del Nervio Hipogloso , Humanos , Enfermedades del Nervio Hipogloso/diagnóstico por imagen , Enfermedades del Nervio Hipogloso/etiología , Difosfatos , Lengua/inervaciónRESUMEN
A 51-year-old woman with papillary thyroid cancer (PTC) complained of headache.Physical examination found the tongue derivation torightside. Fluorine-18-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (18F-FDG PET/MRI) detected a hypermetabolic soft-tissue mass in the right retropharyngeal carotid space, where the nasopharyngeal carotid segment of right hypoglossal nerve passing inferiorly. The musculature in the right side of tongue was inflammatory instead of fatty infiltration, with hyperintense on T2-weighted image and hypermetabolism on PET. These images together indicated the early phase of hypoglossal nerve palsy caused by PTC invasion.
Asunto(s)
Enfermedades del Nervio Hipogloso , Neoplasias de la Tiroides , Femenino , Fluorodesoxiglucosa F18 , Humanos , Enfermedades del Nervio Hipogloso/diagnóstico por imagen , Enfermedades del Nervio Hipogloso/etiología , Imagen por Resonancia Magnética , Persona de Mediana Edad , Tomografía de Emisión de Positrones , Radiofármacos , Cáncer Papilar Tiroideo/diagnóstico por imagen , Neoplasias de la Tiroides/complicaciones , Neoplasias de la Tiroides/diagnóstico por imagenRESUMEN
Aneurysm in the petrous segment of the internal carotid artery is extremely rare, and symptoms are usually derived from compression of neighbor structures such as nerve palsies. Clinical symptoms can be nonspecific and imaging findings are complex, making the diagnosis of this kind of aneurysms extremely challenging. CT angiography is the best diagnostic tool, and treatment options include surgical and endovascular approaches, the latest being preferred. We report an extremely rare case of an aneurysm in the petrous apex presenting with hypoglossal nerve palsy. We document the aneurysm through CT and confirm it using angiography. We also describe the satisfactory management of this rare case. To the best of our knowledge this an extremely rare aneurism presenting with hypoglossal nerve palsy, in which successful interventional management was achieved through a specific and prompt diagnosis.
Asunto(s)
Aneurisma , Enfermedades de las Arterias Carótidas , Enfermedades del Nervio Hipogloso , Aneurisma/complicaciones , Aneurisma/diagnóstico por imagen , Angiografía , Enfermedades de las Arterias Carótidas/complicaciones , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Arteria Carótida Interna/diagnóstico por imagen , Humanos , Enfermedades del Nervio Hipogloso/diagnóstico por imagen , Enfermedades del Nervio Hipogloso/etiologíaAsunto(s)
Enfermedades del Nervio Hipogloso/diagnóstico por imagen , Base del Cráneo/diagnóstico por imagen , Neoplasias Craneales/diagnóstico por imagen , Anciano , Humanos , Enfermedades del Nervio Hipogloso/patología , Masculino , Base del Cráneo/patología , Neoplasias Craneales/patología , Neoplasias Craneales/secundarioRESUMEN
BACKGROUND: An elongated styloid process can less frequently lead to symptomatic compression of the internal jugular vein (IJV). We present the first case of dural arteriovenous fistula (DAVF) in association with compressed IJV by an elongated styloid process. CASE DESCRIPTION: A 77-year-old woman presented with pulsating tinnitus. DAVF at the right hypoglossal canal was diagnosed, and she underwent transvenous embolization. The shunt flow was reduced, and the symptom disappeared after transvenous embolization. However, 2 years and 8 months later, retrograde sinus drainage from the residual shunt was asymptomatically found on magnetic resonance imaging, and angiography revealed progression of IJV stenosis caused by an elongated styloid process. Subsequently, she underwent a second transvenous embolization, and the arteriovenous shunt was almost completely obliterated. CONCLUSIONS: The present case suggests that venous hypertension by compressed IJV can induce the development of DAVF. It is helpful for the diagnosis and treatment of DAVF to keep in mind the possibility of IJV stenosis owing to an elongated styloid process.
Asunto(s)
Malformaciones Vasculares del Sistema Nervioso Central/complicaciones , Malformaciones Vasculares del Sistema Nervioso Central/terapia , Osificación Heterotópica/complicaciones , Osificación Heterotópica/terapia , Hueso Temporal/anomalías , Anciano , Malformaciones Vasculares del Sistema Nervioso Central/diagnóstico por imagen , Angiografía Cerebral , Constricción Patológica , Embolización Terapéutica , Femenino , Humanos , Enfermedades del Nervio Hipogloso/complicaciones , Enfermedades del Nervio Hipogloso/diagnóstico por imagen , Venas Yugulares/diagnóstico por imagen , Imagen por Resonancia Magnética , Osificación Heterotópica/diagnóstico por imagen , Hueso Temporal/diagnóstico por imagen , Resultado del TratamientoRESUMEN
BACKGROUND: Hypoglossal schwannomas are rare, benign intracranial neoplasms; they represent 5% of all nonvestibular schwannomas. CASE DESCRIPTION: A 22-year-old male patient had presented 4 months before admission with left-sided hearing loss, an increase in the base of support with lateralization to the left, and dysphagia to solids. Physical examination on admission showed hypotrophy of the tongue and deviation to the left. Magnetic resonance imaging showed evidence of an extraaxial lesion compressing the medulla oblongata and pons, which protruded through the hypoglossal canal. The patient was prepared for surgical treatment in 2 stages: in the first surgery, a left retrosigmoidal approach with total resection of the intracranial lesion was performed. The biopsy reported a schwannoma, and correlating the signs, symptoms, and imaging, the diagnosis of a hypoglossal nerve schwannoma was established. In the second surgery, a lateral cervical approach was performed, with subtotal resection of the lesion, leaving a remnant adhered to the nerve in the hypoglossal canal. CONCLUSIONS: Hypoglossal schwannomas are a rare entity, in which surgery is the most viable option with high cure rates. However, its complete resection, without leaving permanent neurologic sequels, is a challenge.
Asunto(s)
Neoplasias de los Nervios Craneales/diagnóstico por imagen , Enfermedades del Nervio Hipogloso/diagnóstico por imagen , Neurilemoma/diagnóstico por imagen , Neoplasias de los Nervios Craneales/complicaciones , Neoplasias de los Nervios Craneales/cirugía , Trastornos de Deglución/etiología , Pérdida Auditiva Unilateral/etiología , Humanos , Enfermedades del Nervio Hipogloso/complicaciones , Enfermedades del Nervio Hipogloso/cirugía , Imagen por Resonancia Magnética , Masculino , Neurilemoma/complicaciones , Neurilemoma/cirugía , Adulto JovenRESUMEN
The hypoglossal nerve gives motor innervation to the intrinsic and extrinsic muscles of the tongue. Pathology of this nerve affects the balanced action of the genioglossus muscle causing tongue deviation toward the weak side. Clinically, hypoglossal nerve palsy manifests with difficulty chewing, swallowing and with dysarthric speech herein, we review the anatomy of the hypoglossal nerve as well as common and infrequent lesions that can affect this nerve along its course.
Asunto(s)
Neoplasias Encefálicas/complicaciones , Enfermedades del Nervio Hipogloso/diagnóstico por imagen , Enfermedades del Nervio Hipogloso/patología , Neoplasias Craneales/complicaciones , Neoplasias del Tronco Encefálico/diagnóstico por imagen , Neoplasias del Tronco Encefálico/patología , Glioma/diagnóstico por imagen , Glioma/patología , Humanos , Enfermedades del Nervio Hipogloso/etiología , Neoplasias Meníngeas/complicaciones , Neoplasias Meníngeas/diagnóstico por imagen , Neoplasias Meníngeas/patología , Meningioma/complicaciones , Meningioma/diagnóstico por imagen , Meningioma/patología , Neoplasias Craneales/patología , Lengua/inervaciónAsunto(s)
Enfermedades del Nervio Hipogloso/etiología , Hueso Occipital/lesiones , Fracturas Craneales/complicaciones , Accidentes de Tránsito , Adulto , Humanos , Enfermedades del Nervio Hipogloso/diagnóstico por imagen , Masculino , Hueso Occipital/diagnóstico por imagen , Fracturas Craneales/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Collet-Sicard syndrome is an unusual disorder. The authors here demonstrated the Magnetic resonance (MR) imaging findings of the Collet-Sicard syndrome associated with glomus jugulare tumor. Neoplastic or non-neoplastic lesion of skull base can cause Collet-Sicard syndrome. MR imaging can be used successfully to demonstrate the etiology of this syndrome.
Asunto(s)
Glomo Yugular/diagnóstico por imagen , Enfermedades del Nervio Hipogloso/diagnóstico por imagen , Paraganglioma/diagnóstico por imagen , Enfermedades del Nervio Vago/diagnóstico por imagen , Femenino , Humanos , Enfermedades del Nervio Hipogloso/etiología , Imagen por Resonancia Magnética , Persona de Mediana Edad , Paraganglioma/complicaciones , Enfermedades del Nervio Vago/etiologíaRESUMEN
Few studies have documented the morphology of the intracanalicular segment of the hypoglossal nerve (CSHN). Therefore, the aim of this study was to characterize the CSHN using magnetic resonance imaging (MRI). In total, 95 patients underwent thin-sliced, contrast MRI. The axial and coronal images were used for analysis. The CSHNs were bilaterally identified in 97% and 94% of the 95 patients on the axial and serial coronal images, respectively. On axial images, length of the hypoglossal canal was measured as 8.2⯱â¯1.66â¯mm on the right and 8.4⯱â¯1.71â¯mm on the left. The CSHN was delineated as a slightly tortuous, linear structure with variable length. The CSHN course in the hypoglossal canal could be classified into the ventral, central, and ventrodorsal types, with the ventral type most predominant and found in 65% on the right side and 43% on the left. The angle formed by the CSHN and perpendicular line was highly variable. On serial coronal images, the CSHN course in the hypoglossal canal was also variable and could be found in the any part of the canal. The CSHN is a distinct structure characterized by morphological variability, which can influence the type of hypoglossal neuropathy arising from the CSHN.
Asunto(s)
Enfermedades del Nervio Hipogloso/diagnóstico por imagen , Nervio Hipogloso/anatomía & histología , Nervio Hipogloso/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Adolescente , Adulto , Anciano , Niño , Femenino , Humanos , Enfermedades del Nervio Hipogloso/patología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenAsunto(s)
Enfermedades del Nervio Hipogloso/diagnóstico por imagen , Miocimia/diagnóstico por imagen , Lengua/diagnóstico por imagen , Trastornos de Deglución/etiología , Disartria/etiología , Electromiografía , Femenino , Humanos , Enfermedades del Nervio Hipogloso/complicaciones , Enfermedades del Nervio Hipogloso/fisiopatología , Persona de Mediana Edad , Miocimia/etiología , Miocimia/fisiopatología , Lengua/fisiopatología , UltrasonografíaRESUMEN
BACKGROUND: Isolated hypoglossal nerve palsy caused by an atlantooccipital synovial cyst is a rare lesion, with fewer than 5 cases reported in the literature. CASE DESCRIPTION: Our patient presented with acute hypoglossal nerve dysfunction. Our differential included neoplasm, trauma, stroke, multiple sclerosis, or other inflammatory/infectious etiology. Imaging revealed a peripherally enhancing, extradural focus in the left premedullary cistern, most likely consistent with a synovial cyst. CONCLUSIONS: A left suboccipital craniectomy was performed in the region of the left hypoglossal canal, in which a cystic structure was noted at the occipital condyle and C1 vertebral junction. The nerve was adequately decompressed via aspiration of the cyst. Postoperatively, the patient substantially improved. Although rare, synovial cysts must be included in the differential diagnosis of atlantooccipital lesions.
Asunto(s)
Articulación Atlantooccipital/patología , Enfermedades del Nervio Hipogloso/patología , Quiste Sinovial/patología , Anciano , Articulación Atlantooccipital/diagnóstico por imagen , Humanos , Enfermedades del Nervio Hipogloso/diagnóstico por imagen , Enfermedades del Nervio Hipogloso/etiología , Imagen por Resonancia Magnética , Masculino , Quiste Sinovial/complicaciones , Quiste Sinovial/diagnóstico por imagenRESUMEN
Spontaneous internal carotid artery dissection occurs in patients of all ages, rarely presenting with hypoglossal nerve palsy. The characteristic imaging findings of internal carotid artery dissection and tongue denervation are reviewed in four patients. Recognition of internal carotid artery dissection is critical for appropriate treatment and to minimise the risk of thromboembolic-ischaemic complications. Radiologists must be aware of the radiological appearance of hypoglossal nerve palsy and maintain a high index of suspicion for internal carotid artery dissection when this finding is present.
Asunto(s)
Disección de la Arteria Carótida Interna/complicaciones , Disección de la Arteria Carótida Interna/diagnóstico por imagen , Enfermedades del Nervio Hipogloso/diagnóstico por imagen , Enfermedades del Nervio Hipogloso/etiología , Adulto , Angiografía por Tomografía Computarizada , Femenino , Humanos , Angiografía por Resonancia Magnética , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Cranial pneumatization in humans is normally confined to the paranasal sinuses and the petrous and mastoid parts of the temporal bones. CASE DESCRIPTION: We present a case of left-sided fractures of the occipital condyle and lateral mass of the atlas in the setting of extensive craniocervical pneumatization but in the absence of trauma, with a resulting unilateral hypoglossal nerve palsy. CONCLUSIONS: We discussed the possible etiology of this rare disease, its management, and prognosis.
Asunto(s)
Enfermedades Óseas/complicaciones , Atlas Cervical/lesiones , Fracturas Espontáneas/complicaciones , Enfermedades Óseas/diagnóstico por imagen , Atlas Cervical/diagnóstico por imagen , Fracturas Espontáneas/diagnóstico por imagen , Humanos , Enfermedades del Nervio Hipogloso/diagnóstico por imagen , Enfermedades del Nervio Hipogloso/etiología , Masculino , Persona de Mediana Edad , Hueso OccipitalRESUMEN
Malignant lymphoma sometimes involves peripheral nerves due to paraneoplastic syndrome associated with anti-ganglioside antibodies. We report a very rare case of malignant lymphoma accompanied by an asymmetrical and isolated hypoglossal nerve palsy associated with a new subset of anti-ganglioside antibodies. Magnetic resonance imaging and 18F-2-deoxy-2-fluoro-D-glucose position emission tomography showed no abnormalities of the hypoglossal nerve nucleus; however, the patient' s serum was positive for anti-sulfated glucuronyl paragloboside IgM antibodies as well as anti-GM1 IgM and anti-GQ1b IgM antibodies. The present case might suggest a paraneoplastic asymmetrical and isolated hypoglossal nerve palsy associated with a new subset of anti-ganglioside antibodies.
Asunto(s)
Gangliósido G(M1)/inmunología , Globósidos/inmunología , Enfermedades del Nervio Hipogloso/etiología , Inmunoglobulina M/sangre , Linfoma de Células B Grandes Difuso/complicaciones , Linfoma de Células B Grandes Difuso/inmunología , Anciano , Fluorodesoxiglucosa F18 , Humanos , Enfermedades del Nervio Hipogloso/diagnóstico por imagen , Enfermedades del Nervio Hipogloso/inmunología , Linfoma de Células B Grandes Difuso/diagnóstico por imagen , Imagen por Resonancia Magnética , Masculino , Tomografía Computarizada por Tomografía de Emisión de Positrones , Radiofármacos , Tomografía Computarizada por Rayos XRESUMEN
INTRODUCTION: Spontaneous cervical artery dissection (sCAD) is a major cause of ischemic stroke in young and middle-aged adults, but the occurrence of multiple sCADs could suggest the presence of an underlying arteriopathy. Bilateral hypoglossal nerve palsy caused by extracranial internal carotid artery dissections have been rarely described. We present the case of a 3-vessel sCAD in a patient with repaired tetralogy of Fallot (ToF). CASE REPORT: A 50-year-old man was admitted to our stroke unit for a sudden onset of left cervical pain, mild left ptosis, dysarthria, and dysphagia. His medical history was remarkable for surgically repaired ToF. Neurological examination showed left Claude-Bernard-Horner syndrome and bilateral hypoglossal palsy. Diffusion-weighted magnetic resonance imaging excluded parenchymal lesions while magnetic resonance angiography showed a pattern of bilateral extracranial internal carotid and right vertebral dissection. CONCLUSIONS: This is the first case of multiple-vessel sCAD, and more associated with an unusual clinical presentation, in a patient with surgically repaired ToF, supporting the hypothesis that defective large artery elastogenesis plays a role in this congenital disorder, and suggesting the importance of continuous long-term vascular follow-up.