Unilateral hypoglossal nerve palsy due to neurovascular conflict in a child

A neurovascular conflict (NC) consists of a pathological contact between a vessel, generally an artery, and the root entry zone of a cranial nerve close to the brainstem. Even if NC of the V, VII and IX cranial nerve have been rarely described, to the best of our knowledge there is no report about the XII cranial nerve NC in the paediatric age. A three-year-old girl presented with right-sided tongue atrophy and fasciculation, of one-year-duration, consistent with a peripheral lesion of the right XII cranial nerve. Brain MRI and MRA documented a marked tortuosity of the vertebrobasilar arteries compressing the brainstem at the emergency of the XII cranial nerve, while the CT disclosed a concomitant osseous malformation of the cranio-cervical junction. The differential diagnosis of a peripheral unilateral cranial nerve palsy should include, even if rare in children, a neurovascular conflict. In this case a complete neuroimaging study is indicated.     

Isolated unilateral hypoglossal nerve palsy: nine cases

We report nine patients with hypoglossal nerve palsy as the sole neurological manifestation, without simultaneous involvement of other cranial nerves or long-tract signs. In four patients, no cause was found and the outcome was excellent. The next common cause proved to be metastatic disease at the base of the skull in three patients. Two exceptional causes were Chiari malformation in one case and dural arteriovenous fistula of the transverse sinus in another. Although the aetiological importance and ominous prognosis of neoplasia has been emphasized by others, our study suggests that an isolated hypoglossal nerve palsy may be benign and idiopathic. Received: 21 July 1997 Received in revised form: 1 October 1997 Accepted: 8 October 1997     

Clipping of a vertebral artery aneurysm behind the hypoglossal nerve under the monitoring of lower cranial nerves

Under an operative view, an aneurysm of the vertebral artery is located behind the lower cranial nerves. To prevent neurological deficits we employed electrophysiological monitoring while clipping an aneurysm of the vertebral artery. A 64-year-old woman had suffered a sudden severe headache in the morning. Computed tomography (CT) revealed a subarachnoid hemorrhage (SAH) and CT angiography revealed an aneurysm at a branching point of the left vertebral artery. The condylar fossa approach was taken while recording electromyography (EMG) of the lower cranial nerves. The aneurysm was located just behind the hypoglossal nerve and could not be clipped without strong traction of the hypoglossal nerve. Therefore, the hypoglossal nerve was divided to separate the lower two bundles of the hypoglossal nerve from the other bundles, and the clip was applied to the aneurysm between the nerve bundles without any change of the tongue EMG. The patient went home 10 days after operation with no neurological deficit. In conclusion, we report a case of a ruptured aneurysm of a vertebral artery, which was clipped while monitoring the lower cranial nerves. Tongue EMG monitoring enabled us to clip the aneurysm without nerve injury and revealed that the hypoglossal nerve near the hypoglossal canal can be divided into several bands without neurological deficit.     

Hypoglossal nerve palsy as an isolated syndrome of internal carotid artery dissection: A review of the literature and a case report

A review of literature on the dissection of internal carotid artery was presented with a presentation of a rare case of patient with transient left hypoglossal nerve palsy caused by mechanic compression from intramural hematoma in higher extracranial portion of dissected carotid artery confirmed in MRI and CT scans. The clinical presentation and management are discussed.     

Symptomatic medulla compression by vertebral artery

Objective

Vertebral artery medulla compression syndrome (VAMCS) is a very rare condition manifesting as different neurological focal deficits. The case of a 36-year-old male with symptomatic brainstem compression by vertebral artery (VA) treated by means of microvascular decompression (MVD) and a review of the literature is presented.

Isolated accessory nerve palsy. Case report

A case of isolated accessory nerve palsy with wasting of the trapezius and sternocleidomastoid muscle is presented. The conduction velocity of the nerve was found to be decreased. Attention is drawn to the electromyographic pattern of continuous pseudomyotonic discharge. No causes of the palsy could be detected. The case is discussed and compared with the other reported cases of accessory nerve palsy of spontaneous origin.

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Sommario Si presenta un caso di paralisi isolata del nervo accessorio spinale con atrofia dei muscoli sternocleido-mastoideo e trapezio. Particolare rilievo è dato al reperto elettromiografico che dimostra una riduzione della velocità di conduzione del nervo e la presenza di continue scariche pseudomiotoniche. Il caso è discusso e confrontato con gli altri casi riportati dalla letteratura di paralisi del nervo accessorio di origine spontanea.

     

Facial nerve palsy in posterior fossa arachnoid cysts: report of two cases

Case report Two patients with a posterior fossa arachnoid cyst responsible for isolated facial nerve palsy are reported.Discussion The relationships between the cyst and the facial nerve and between the facial nerve palsy and the size variation of the cyst are discussed and documented by pre- and postoperative magnetic resonance imaging.     

Isolated bilateral abducens nerve palsy due to an inflammatory process within the sella and parasellar regions

Isolated bilateral abducens nerve palsy raises concern about a serious intracranial condition. Abducens nerve palsy is a common isolated palsy due to its susceptibility to injury along its long course. Non-traumatic isolated abducens nerve palsy is often caused by a mass that indirectly stretches and compresses the nerve. Pathological processes directly causing bilateral isolated involvement of the abducens nerve are rare. We describe a 24-year-old man who presented with isolated bilateral abducens nerve palsy. Radiological imaging and laboratory tests were consistent with an aggressive bacterial infectious process located in the sellar region with parasellar extension. If promptly addressed, sixth cranial nerve palsy appears to be reversible with aggressive medical therapy and endoscopic sinus surgery.     

Isolated sixth nerve palsy: an uncommon presenting sign of multiple sclerosis

We describe three patients in whom an isolated sixth nerve palsy was the only clinical symptom or sign of multiple sclerosis (MS). Data were collected prospectively over 6 years on these three patients, who showe no other signs of brainstem dysfunction or prior symptoms; in addition. Retrospective analysis of all patients with MS and all patients with sixth nerve palsy referred to a neuro-ophthalmology service between 1982 and 1998 showed isolated sixth nerve palsy to be the presenting sign of MS in only 0.5% of these patients. MS was the cause of isolated sixth nerve palsy in 0.8% of all patients and in 1.6% of those aged 18–50 years. Although it has been previously suggested that sixth nerve palsy is an ot uncommon presenting sign of MS, our results suggest it is rare. Received: 15 November 1999/Received in revised form: 15 March 2000/Accepted: 26 April 2000     

颈动脉内膜剥脱术致周围性舌下神经麻痹综合康复治疗:1例报道及文献复习

目的:周围性舌下神经麻痹的临床诊治率较低,相当一部分患者未能得到及时而正确的康复治疗。本文旨在报道颈动脉内膜剥脱术致周围性舌下神经麻痹的综合康复治疗方法及临床疗效。方法:2016年3月1日,天津医科大学总医院康复医学科收入1例颈动脉内膜剥脱术致周围性舌下神经麻痹患者,对该患者进行包括舌肌运动训练、神经肌肉电刺激疗法和远红外线治疗在内的为期15 d的综合康复治疗及口服神经营养药物治疗。回顾性分析诊治过程,并对相关文献进行复习。结果:接受综合康复治疗15 d后,舌肌较治疗前灵活,构音较治疗前清晰,吞咽时对食团的控制能力和搅拌能力均得到改善;伸舌虽然仍略向右偏斜,但舌正中沟与正中线的夹角较治疗前减少17.5°;右侧舌体表面皱褶减少,舌体饱满红润;舌尖向上可触及上嘴唇;向左舔嘴角时费力程度减轻;向右伸舌时颈部肌肉张力明显降低;向口腔内部卷曲舌尖可触及软腭边缘。康复治疗效果令人满意。结论:周围性舌下神经麻痹的康复治疗方法鲜见报道。在口服神经营养药物的基础上,同时应用舌肌运动训练、神经肌肉电刺激疗法和远红外线治疗在内的康复治疗方法,可以有效地改善患者的舌肌运动功能和舌肌萎缩程度,成为改善周围性舌下神经麻痹的安全而有效的康复治疗方法。     

椎动脉内膜切除治疗椎动脉起始部狭窄二例报告

目的探讨椎动脉内膜切除治疗椎动脉起始部狭窄的手术效果。方法对二例椎动脉内膜切除手术进行了回顾性分析。结果临床症状明显改善。磁共振血管造影显示术后椎动脉起始部狭窄管腔恢复。结论椎动脉内膜切除术是治疗动脉粥样硬化引起的椎动脉起始部狭窄可行的、有效的方法。     

Extracranial vertebral artery dissection: nine cases

Summary Nine patients (six men, three women) with extracranial vertebral artery dissection are described. Their mean age was 39.1 years (range 17–66). In four cases dissection was spontaneous; in the other five cases there was a history of trivial trauma. Three patients had fibromuscular dysplasia, two were migraineurs, one had elastorrhexis. Treatment varied. Six received heparin, three acetylsalicylic acid or ticlopidine. Eight had good recovery. Two patients experienced recurrence when stopping acetylsalicylic acid. The pathogenesis of dissections and the distinction between spontaneous dissections and those associated with minor trauma are discussed.     

Isolated, unilateral, reversible palsy of the hypoglossal nerve.

We report three patients with isolated unilateral hypoglossal nerve palsy who experienced an excellent outcome. In two patients no cause was found. Our study seems to confirm that the occurrence of benign and idiopathic isolated unilateral palsy of the hypoglossal nerve is more frequent than previously reported. We would like to stress that neuroimaging studies remain mandatory in order to exclude other common causes, such as tumour and spontaneous or traumatic vascular lesions, in which a specific treatment is necessary.     

Isolated trochlear palsy due to midbrain stroke

Trochlear palsy from intra-axial lesions usually accompanies other neurological deficits, and isolated trochlear palsy due to midbrain stroke is extremely rare. We report two patients with isolated trochlear nerve palsy due to circumscribed dorsal midbrain strokes, one from infarction and the other from hemorrhage, which are located in the region of the trochlear nucleus or adjacent fascicle. Focal brain stem stroke should be considered as a rare cause of trochlear palsy even though there are no associated neurological deficits.     

Resolution of Isolated Unilateral Hypoglossal Nerve Palsy Following Microvascular Decompression of the Intracranial Vertebral Artery

Isolated hypoglossal nerve paresis due to mechanical compression from a vascular lesion is very rare. We present a case of a 32-year-old man who presented with spontaneous abrupt-onset dysarthria, swallowing difficulty and left-sided tongue atrophy. Brain computed tomographic angiography and magnetic resonance imaging of the brainstem demonstrated an abnormal course of the left vertebral artery compressing the medulla oblongata at the exit zone of the hypoglossal rootlets that was relieved by microvascular decompression of the offending intracranial vertebral artery. This case supports the hypothesis that hypoglossal nerve palsy can be due to nerve stretching and compression by a pulsating normal vertebral artery. Microvascular decompression of the intracranial nerve and careful evaluation of the imaging studies can resolve unexpected isolated hypoglossal nerve palsy.     

Lower cranial nerve palsy produced by internal carotid artery dilatation. Report of two cases

We report two cases of lower cranial nerve palsies (XII in case 1, IX–X–XII in case 2) associated with abnormalities of the internal carotid artery at the base of the skull. In case 1 a limited dissection of the carotid wall produced both paresis of the hypoglossal nerve and Horners syndrome by compression of the nerve trunk against the base of the skull and stretching of the periarterial sympathetic fibres respectively. In case 2 we speculate that a narrow angled kinking of the internal carotid artery may have damaged cranial nerves IX, X and XII by interfering with the blood supply to the nerve trunks. In both cases the outcome was favorable with almost complete regression of the initial symptoms. We conclude that the association between lower cranial nerve disturbances and internal carotid artery abnormalities is probably more common than was thought. We suggest that the pathogenesis of the damage to the cranial nerves may differ from one case to the next.

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Riassunto Gli Autori riportano due casi di paralisi dei nervi cranici bulbari (XII nel caso 1, IX–X–XII nel caso 2) causate da anomalie dell'arteria carotide interna alla base cranica. Nel caso 1 la paresi del XII nervo cranico, associato con sindrome di Claude Bernard Horner ipsilaterale, è state determinata da un anuerisma dissecante della carotide con conseguente compressione del tronco nervoso contro la base cranica e stiramento delle fibre simpatiche periarteriose. Nel caso 2 viene ipotizzato che la lesione del IX, X e XII nervo cranico sia stata di origine ischemica per la presenza di un'ansa ad angolo acuto dell'arteria carotide interna. In entrambi i casi il decorso è stato favorevole, con regressione pressochè completa dei sintomi iniziali. L'associazione fra anomalie della carotide interna e disturbi dei nervi cranici bulbari è probabilmente più frequente di quanto si ritenesse in precedenza e la patogenesi della lesione nervosa può essere variabile da caso a caso.

     

Isolated sixth nerve palsy secondary to spontaneous intracranial hypotension

We report the case of a 43-year-old gentleman who presented with an isolated left sixth nerve palsy in association with postural headache. Magnetic resonance imaging showed dural enhancement with downward displacement of the brainstem. This, in association with the signs, symptoms and findings on lumbar puncture, confirmed the diagnosis of spontaneous intracranial hypotension. Treatment was successful with epidural blood patching. The case is discussed and the relevant literature reviewed.     

Hypoglossal nerve palsy: 245 cases

Introduction: Apart from a case series of 100 subjects in 1996 and several small cohorts, there have been no large retrospective series of cranial nerve XII (CN XII) palsy. Methods: From 1984 to 2014, 245 cases of CN XII palsy were identified via retrospective chart review using historical and exam findings that confirmed the diagnosis. In addition to clinical characteristics, univariate and multivariate models were investigated to predict neoplastic CN XII palsy. Results: Major etiologic categories included: postoperative (29.3%), idiopathic (15.1%), primary neoplastic (14.2%), metastatic malignancy (13.0%), inflammatory (7.3%), radiation (6.1%), and traumatic (4.1%). A multivariate model revealed male gender and a personal history of cancer as predictive of neoplastic CN XII palsy. Conclusions: The most frequent etiologies and disease categories of CN XII palsy were identified, and male gender and personal history of cancer were found to be predictive of a neoplastic cause of CN XII palsy. Muscle Nerve 54 : 1050–1054, 2016