Isolated hypoglossal nerve palsy caused by carotid artery dissection – the necessity of MRI for diagnosis
Isolated hypoglossal nerve palsy caused by carotid artery dissection – the necessity of MRI for diagnosis
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颈动脉夹层引起的孤立性舌下神经麻痹——MRI诊断的必要性
DOI：
10.1007/s004150170081
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发表时间：
2001
影响因子：
6
通讯作者：
R. Töpper
中科院分区：
文献类型：
--
作者：
C. Spitzer;M. Mull;R. Töpper
先生们：第十二神经麻痹有多种原因，如颅底恶性肿瘤、外伤、神经鞘瘤、脑膜癌、颈动脉手术和感染性疾病等[2,4,12]。有时，尽管进行了广泛的调查，也找不到原因。因此，这些病例被归类为特发性麻痹。直到最近几年，人们才认识到舌下神经麻痹很少是由自发性颈内动脉（ICA）夹层引起的。在大多数情况下，这些患者会出现其他症状，例如同侧霍纳综合征或其他下颅神经病变[1,5,11]。因此，ICA 夹层必须包含在孤立性第十二神经麻痹的鉴别诊断中，并且应通过磁共振成像（MRI）进行评估，正如我们的病例所证明的那样。一名39岁的工程师左下颌角持续疼痛数周。他不记得任何最初的创伤。入院前大约 10 天，患者出现舌头活动困难。临床检查发现左侧舌下神经麻痹：舌头伸出时偏向左侧，在口腔中休息时偏向右侧，舌头运动受损。没有观察到其他神经功能缺陷；特别是，没有明显的其他脑神经病变或霍纳综合征。大脑和颅底的计算机断层扫描没有发现任何异常，特别是舌下管不明显。脑脊液和血液常规分析正常。 MRI（飞利浦陀螺仪 0.5T）显示左侧 ICA 存在局限性解剖，从远端颈椎延伸至近端岩骨段约 20 毫米（图）。 T2加权图像和脂肪抑制的T1加权图像中的高信号清楚地表明动脉周围存在半月形的壁内血肿。它的最大延伸位于背外侧表面。没有给编辑的信
Sirs: XIIth nerve palsy has a variety of causes such as malignant tumors in the base of the skull, trauma, neurinomas, meningeosis carcinoma, surgery of the carotid artery and infectious diseases [2, 4, 12]. Sometimes, no reason can be found despite extensive investigations. These are therefore cases categorized as idiopathic palsies. Only in recent years has it been recognized that hypoglossal nerve palsy can rarely be caused by spontaneous internal carotid artery (ICA) dissection. In most cases these patients present with additional symptoms such as ipsilateral Horner’s syndrome or lesions of other lower cranial nerves [1, 5, 11]. ICA dissection must therefore be included in the differential diagnosis of isolated XIIth nerve palsy and should be assessed by magnetic resonance imaging (MRI) as is demonstrated by our case. A 39-year-old engineer had suffered from persistent pain at the left mandibular angle for several weeks. He could not remember any initiating trauma. Approximately 10 days before admission the patient had experienced difficulty in moving his tongue. Clinical examination revealed a left hypoglossal nerve palsy: The tongue deviated to the left side when protruded, was positioned to the right when resting in the oral cavity and tongue movements were impared. No other neurological deficit could be observed; in particular, no other cranial nerve affection or Horner’s syndrome was evident. Computed tomography of the brain and base of the skull did not reveal any abnormality, in particular, the hypoglossal canal was inconspicuous. Routine analysis of the cerebrospinal fluid and blood was normal. MRI (Philips Gyroscan 0,5T) revealed a circumscribed dissection of the left ICA extending for approximately 20 mm from the distal cervical into the proximal petrosal segment (Figure). The hyperintense signal in the T2weighted images and in the T1weighted images with fat suppression clearly indicated an intramural hematoma surrounding the artery with a semilunar shape. Its maximum extension was on the dorso-lateral surface. There was no LETTER TO THE EDITORS