Bilateral injury to the hypoglossal nerve

The hypoglossal nerve supplies motor function to the tongue. Two cases of bilateral, post-traumatic injury to the hypoglossal nerve are described. Physical and electromyographic examinations in these cases showed evidence of bilateral injury to the hypoglossal nerve as well as the absence of injury to the other closely associated cranial nerves. (A review of the English literature in the past 20 years shows no cases of isolated bilateral damage to the hypoglossal nerve, although there are several cases of unilateral or combined injury.) The disabilities resulting from hypoglossal nerve palsy and the importance of the tongue in normal swallowing are discussed. Two possible causes of hypoglossal nerve palsy are offered.     

Hypoglossal nerve palsy from cervical spine involvement in rheumatoid arthritis: 3 case reports

Rheumatoid arthritis (RA) involvement of the cervical spine is a well-known but perhaps underappreciated phenomenon. Neurologic complications of this involvement include pain, myelopathy, and cranial nerve (CN) palsies. However, hypoglossal nerve palsy (CN XII) is rarely diagnosed. Mechanical nerve injury, either from vertical odontoid subluxation or pannus formation, is the suspected mechanism. We present 2 cases of hypoglossal nerve palsy attributed to cervical spine involvement of RA and 1 case of postoperative tongue weakness after cervical fusion in a patient with long-standing RA. These cases show a potentially devastating complication of RA that may be underdiagnosed. Therapy involving the cervical spine must be prescribed with caution in this patient population.     

Accelerated Nerve Regeneration in Mice by upregulated expression of interleukin (IL) 6 and IL-6 receptor after trauma

In this study we aimed to examine a role for interleukin 6 (IL-6) and its receptor (IL-6R) in peripheral nerve regeneration in vivo. We first observed that cultured mouse embryonic dorsal root ganglia exhibited dramatic neurite extension by simultaneous addition of IL-6 and soluble IL-6R (sIL-6R), a complex that is known to interact with and activate a signal transducing receptor component, gp130. After injury in the hypoglossal nerve in adult mice by ligation, immunoreactivity to IL-6 was upregulated in Schwann cells at the lesional site as well as in the cell bodies of hypoglossal neurons in the brain stem. In the latter, upregulation of the immunoreactivity to IL-6R was also observed. Regeneration of axotomized hypoglossal nerve in vivo was significantly retarded by the administration of anti-IL-6R antibody. Surprisingly, accelerated regeneration of the axotomized nerve was achieved in transgenic mice constitutively expressing both IL-6 and IL-6R, as compared with nontransgenic controls. These results suggest that the IL- 6 signal may play an important role in nerve regeneration after trauma in vivo.     

Cranial nerve XII: The hypoglossal nerve

The hypoglossal nerve, cranial nerve XII, is the motor supply of the tongue. An understanding of the intracranial and extracranial components is fundamental in the evaluation of hypoglossal pathology. The following discussion of the evaluation of the hypoglossal nerve will involve the embryology, anatomy, clinical basis, and imaging techniques with pathologic correlations.     

特发性单侧舌下神经麻痹1例报告

Isolated hypoglossal nerve palsy(IHNP) is a rare condition.There are a few reports in the literature of isolated,unilateral hypoglossal nerve palsy secondary to an infectious process,vaccination,aneurysms,trauma,caries,dislocation of vertebrae,and intracranial tumor.We report a case of unilateral,isolated hypoglossal nerve palsy with full recovery.     

MR三维颅脑容积成像增强扫描序列在舌下神经管区病变中的应用

目的 探讨三维MR颅脑容积成像（3D-BRAVO）增强扫描序列在舌下神经管区病变中的应用价值。方法 对14例舌下神经管区病变患者的MR资料进行回顾性分析,所有病例均行常规MR平扫、增强及3D-BRAVO增强扫描。结果 14例患者于常规平扫序列上可发现病灶,常规增强序列上不能清晰显示舌下神经及舌下神经管,三维颅脑容积成像增强扫描序列上所有病例均能显示舌下神经及舌下神经管,并可进行MPR多方位清楚显示舌下神经管、舌下神经及病灶。结论 3D-颅脑容积成像增强扫描序列较常规扫描提供更多信息,是诊断舌下神经管区病变准确、可靠的扫描序列。     

Horseradish peroxidase and cobalt chloride as neuromarkers in the hypoglossal nucleus

Summary The hypoglossal nucleus in 129 REJ normal mouse strains was investigated using two neuroanatomical markers, namely the cobalt chloride (CoCl₂) and the horseradish peroxidase (HRP) techniques. CoCl₂ was introduced through the cut end of the hypoglossal nerve. In one set of experiments HRP was injected into the hypoglossal nerve, while in the other it was injected into the tongue musculature. Results show that with these techniques the hypoglossal neurons are conspicuously stained and can be easily located among series of brainstem sections. The mean number±SD of neurons in the hypoglossal nucleus was 1,417±37, 846±28 and 1,272±42 using CoCl₂ and HRP injected into the tongue musculature or the hypoglossal nerve, respectively. The estimated length of the nucleus was 0.92 mm with the CoCl₂ technique.     

Unilateral headache and hypoglossal nerve palsy: a report of three cases

Ipsilateral headache associated with hypoglossal nerve palsy is uncommon and is usually reported to be secondary to internal carotid artery dissection. Herein, we report three idiopathic cases of berign ipsilateral headache with hypoglossal nerve palsy.     

Insertion of intra-oral electrodes for cranial nerve monitoring using a Crowe–Davis retractor

Acoustic neuroma resection is an example of a neurosurgical procedure where the brainstem and multiple cranial nerves are at risk for injury. Electrode placement for monitoring of the glossopharyngeal and hypoglossal nerves during acoustic neuroma resection can be challenging. The purpose of this report is to illustrate the use of a device for intra-oral electrode placement for intraoperative monitoring of the glossopharyngeal and hypoglossal nerves. A 60-year-old male presented for acoustic neuroma resection. Under general anesthesia, a Crowe–Davis retractor was used to open the mouth, providing access to the posterior pharynx. For glossopharyngeal monitoring, two bent subdermal needle electrodes were inserted just lateral to the uvula. Two additional electrodes were inserted on the lateral tongue to monitor the hypoglossal nerve. Cranial nerves monitoring was conducted utilizing both free running and triggered electromyography of the trigeminal and facial nerves in addition to the lower cranial nerves. The tumor was resected successfully. Monitoring of the cranial nerves (including the glossopharyngeal and hypoglossal nerves) revealed no concerning responses. The Crowe–Davis retractor and the technique described allowed insertion of electrodes for neural monitoring, contributing to neural preservation.     

颅内外型舌下神经鞘瘤的MRI诊断

目的探讨颅内外型舌下神经鞘瘤的MRI特点。方法回顾性分析经手术病理证实的4例颅内外型舌下神经鞘瘤的MRI表现。结果病灶均呈哑铃形,表现为局部软组织肿块阴影,在T1WI上呈等或稍低信号,T2WI呈稍高信号,增强后有明显的环状或不均匀强化,边界均较清晰,同时可见舌下神经孔扩大4例,见线条状增粗的舌下神经与病灶相连3例。结论颅内外型舌下神经鞘瘤具备较特征性的MRI表现。     

Focal lingual dystonia,urinary incontinence,and sensory deficits secondary to low voltage electrocution: case report and literature review

Electrocution injuries are well reported in review articles and cases of high voltage electrocution injury are abundant. However, reports of low voltage electrocution injury are few. A case is presented of low voltage shock from a 120 volt AC source with presentation, acute and chronic course, and a five year follow up. The patient experienced several unusual complications of low voltage electrocution: a persistent right tongue deviation, which initially presents as an isolated hypoglossal nerve palsy, but subsequently manifests as a focal lingual dystonia; total body paresthesia with urinary incontinence; and persistent sensory deficits to the face and tongue.     

探索一种敏感性较高神经通路追踪方法的实验观察

背景神经纤维溃变法和辣根过氧化物酶顺行追踪法是研究神经通路的常用方法,这两种方法都存在标记区域不清和敏感性较差的缺陷而不能充分恒定地显示神经纤维的投射区,为了更有效的研究神经通路,需要不断探索新的神经通路追踪方法.目的寻找一种高效敏感的神经通路追踪方法,为研究神经再生提供一种简便、客观、可靠的观察方法.设计以实验动物为研究对象,随机对照的实验研究.单位一所大学职工医院内科和一所大学实验技术教研室.材料实验在成都医学院实验技术教研室完成,用华西医科大学实验动物中心提供的成年健康雄性SD大鼠6只作为实验动物.方法采用结合了霍乱毒素亚单位B的辣根过氧化物酶(CB-HRP)作为示踪剂,用钨酸钠作为四氨基联苯胺(TMB)显色剂的稳定剂,顺行追踪视神经纤维向下丘脑前区的投射;逆行追踪舌下神经纤维在延髓背侧的分布.主要观察指标神经元胞体和神经纤维的分布和染色情况.结果视神经纤维投射到视交叉上核背内侧;舌下神经纤维投射到延髓背侧的舌下神经核区,结果显示神经元的胞体和轴突结构清晰.结论用CB-HRP作为示踪剂,以钨酸钠作为四氨基联苯胺显色剂的稳定剂的方法是一种高效敏感的神经通路追踪方法.     

Evaluation of peripheral nerve injury

Common etiologies of peripheral nerve injury include penetrating injury, crush, stretch, and ischemia. Management of nerve injury requires familiarity with the relevant anatomy, pathology, pathophysiology, and the surgical principles, approaches and concerns. Surgical repair is done at varying time intervals after the injury, and there are a number of considerations in deciding whether and when to operate. In neurapraxia, the compound muscle action and nerve action potentials on stimulating distal to the lesion are maintained indefinitely; stimulation above the lesion reveals partial or complete conduction block. The picture in axonotmesis and neurotmesis depends on the time since injury. The optimal timing for an electrodiagnostic study depends upon the clinical question being asked. Proximal nerve injuries are problematic because the long distance makes it difficult to reinnervate distal muscles before irreversible changes occur. In the early management of peripheral nerve injury, control of pain is often the most pressing consideration and a number of approaches may be used to bring relief.     

Perioperative and Perianesthesia Considerations for Hypoglossal Nerve Stimulator Implantation in Obstructive Sleep Apnea Patients

Hypoglossal nerve stimulation (Inspire Medical Systems, Maple Grove, Minnesota) is an innovative treatment option for eligible patients with moderate to severe obstructive sleep apnea (OSA). Since U.S. Food and Drug Administration approval in 2014, over 18,000 patients have been implanted. The device includes an implanted pacemaker-sized pulse generator, one sensing lead, and one stimulation lead. During sleep, inspirations and expirations are detected by the sensing lead. At end expiration, the stimulation lead triggers the hypoglossal nerve to contract and stiffen the tongue thus preventing airway obstruction and improving OSA. Perioperative and perianesthesia nurses have an important role in caring for these patients during all aspects of the surgical insertion process: evaluation for eligibility, device implantation, and future visits to the perioperative area for related and unrelated procedures. This article reviews anatomic and physiologic factors contributing to airway collapse in OSA, function of the hypoglossal nerve stimulation device, the evaluation, implantation, and activation process, and considerations for patient care in the perioperative and perianesthesia periods. Precautions needed for other therapies, including Magnetic Resonance Imaging, diathermy, and radiation are also discussed.     

兔坐骨神经电损伤后神经组织超微结构观察

目的：研究兔坐骨神经电损伤后神经组织和雪旺氏细胞超微结构变化。 方法：随机将实验动物按损伤电压分为3组：55V组、110V组、220V组，建立电损伤动物模型。对电击后不同时程兔坐骨神经进行取材固定，利用透射电子显微镜观察其超微结构。 结果：（1）坐骨神经55V电损伤4周后，神经结构即恢复正常；(2)110V电损伤2周时，神经破坏加重，雪旺氏细胞增殖，16周时神经结构基本恢复正常；(3)220V电损伤时雪旺氏细胞被破坏，观察16周仍未见神经恢复。 结论：神经组织在受到电损伤后超微结构随损伤电压的增大而改变明显；周围神经电击伤后神经再生能力与雪旺氏细胞相关，雪旺氏细胞的恢复可能是神经能够成功再生的必要保证。     

Alternative route to a hypoglossal canal dural arteriovenous fistula in case of failed jugular vein approach

Hypoglossal canal dural arteriovenous fistulas (HC-DAVF) involve the anterior condylar vein (ACV) and anterior condylar confluence (ACC). They often present with tinnitus, bruit, and hypoglossal nerve palsy. The most common treatment in HC-DAVFs is transvenous embolization using coils and the most direct transvenous route is the trans-internal jugular vein access. When this approach is not feasible, a treatment attempt is possible through alternative routes. We report 2 patients with DAVFs involving the anterior condylar confluence. The first patient presented with pulsatile tinnitus and hypoglossal nerve palsy, and was treated by a standard transjugular approach. The second patient presented with pulse-synchronous bruit. Following an unsuccessful attempt of the transjugular approach, the fistulous point was reached via the deep cervical vein and complete occlusion was achieved by coil deployment. Both patients had complete regression of symptoms. Endovascular therapy is the elective treatment for HC-DAVFs and the transjugular approach is the most commonly used. The deep cervical vein (DCV) can be an alternative transvenous route when the transjugular approach fails.     

Superficial radial neuropathy following venepuncture

A 42-year-old female suffered excruciating pain and paraesthesia on venepuncture of the cephalic vein in her left wrist. The left superficial radial nerve was injured. A flexed wrist during venepuncture renders the superficial radial nerve immobile and vulnerable to being punctured by the needle. To reduce the risk of nerve injury during venepuncture, the phlebotomist should choose a large and visible vein and insert the needle at a 5-15 degrees angle with the skin. The wrist should be selected only if the veins in the antecubital area are deemed unsuitable. The feeling of an electric shock along the distribution of the nerve, or rupture of the vein during venepuncture, should alert the phlebotomist to the possibility of nerve injury and the procedure should be stopped immediately.     

Herpes simplex virus vector-mediated delivery of neurturin rescues erectile dysfunction of cavernous nerve injury

Neurturin (NTN), a member of glial cell line-derived neurotrophic factor (GDNF) family, is known as an important neurotrophic factor for penis-projecting neurons. We recently demonstrated significant protection from erectile dysfunction (ED) following a replication-defective herpes simplex virus (HSV) vector-mediated GDNF delivery to the injured cavernous nerve. Herein, we applied HSV vector-mediated delivery of NTN to this ED model. Rat cavernous nerve was injured bilaterally using a clamp and dry ice. For HSV-treated groups, 20 microl of vector stock was administered directly to the damaged nerve. Delivery of an HSV vector expressing both green fluorescent protein and lacZ (HSV-LacZ) was used as a control. Intracavernous pressure along with systemic arterial pressure (ICP/AP) was measured 2 and 4 weeks after the nerve injury. Fluorogold (FG) was injected into the penile crus 7 days before being killed to assess neuronal survival. Four weeks after nerve injury, rats treated with HSV-NTN exhibited significantly higher ICP/AP compared with untreated or control vector-treated groups. The HSV-NTN group had more FG-positive major pelvic ganglion neurons than the control group following injury. HSV vector-mediated delivery of NTN could be a viable approach for the improvement of ED following cavernous nerve injury.     

颈动脉体瘤分型与手术治疗九例回顾性分析

目的探讨颈动脉体瘤分型、诊断和手术方法。方法1996年11月-2006年2月收治的颈动脉体瘤9例,其中ShamblinⅠ型4例,Ⅱ型1例,Ⅲ型4例,术前均行DSA。单纯瘤体切除4例,瘤体切除并颈外动脉结扎1例,瘤体切除并颈内静脉、颈内动脉、颈外动脉、迷走神经切除1例,瘤体、颈外动脉切除并颈内、颈总动脉端端吻合2例,瘤体、颈外动脉切除并颈总-颈内动脉自体静脉移植术1例。结果1例手术后1年复发,再次手术后3d死亡;2例舌下神经损伤,其中暂时性舌瘫1例,永久性舌瘫1例。结论DSA在颈动脉体瘤诊断和指导治疗中起重要作用,根据分型选择合理的手术方法,疗效佳且并发症少。     

Isolated unilateral hypoglossal nerve palsy due to vertebral artery dissection

We report the case of a patient with unilateral tongue weakness secondary to an isolated lower motor neuron hypoglossal nerve palsy that was caused by a right vertebral artery dissection in the lower neck. The patient had a boggy tongue with a deviation to the right side but an otherwise normal neurological examination. Magnetic resonance angiography showed a narrow lumen of the right vertebral artery in the neck. After initially treating the patient with aspirin in the emergency room and later with warfarin for three months, there was complete recanalization of the right vertebral artery. Only one other case of vertebral artery dissection and twelfth nerve palsy has been reported before.