Hypoglossal nerve palsy secondary to cervical spine involvement in rheumatoid arthritis: clinical and radiological features.
Isolated hypoglossal nerve (HN) palsy has been reported in a variety of disorders involving the cervical spine and/or skull base, however, unilateral HN palsy caused by rheumatoid arthritis (RA) has rarely been reported. We report herein an uncommon case of isolated HN palsy secondary to RA cervical spine involvement: pannus formation at the C1-C2 articulation, atlanto-axial subluxation, as well as, erosion of the right occipital condyle, lateral mass and anterior arch of C1. Pulse therapy with methylprednisolone followed by maintenance therapy with prednisone resulted in dramatic improvement. We also present the variety of diagnostic modalities helpful for the diagnosis and follow-up.
Zeina
Abdel-Rauf
AR
Department of Radiology, Hillel Yaffe Medical Center, 38100 Hadera, Israel. raufzeina3@hotmail.com
Nachtigal
Alicia
A
Avshovich
Nina
N
Rosner
Itzhak
I
Rozenbaum
Michael
M
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology*; D004401:Dysarthria / Q000209:etiology; D006801:Humans; D020437:Hypoglossal Nerve Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D014060:Tongue Diseases / Q000209:etiology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors / Q000276:immunology
D000894:Anti-Inflammatory Agents, Non-Steroidal; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha