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03-01-2024 | Rheumatoid Arthritis | CLINICAL IMAGE

Hypoglossal nerve palsy due to basilar impression in rheumatoid arthritis

Authors: Tatsunori Shizuku, Noboru Hagino

Published in: Clinical Rheumatology | Issue 3/2024

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Excerpt

A 70-year-old Asian male, undergoing treatment for seropositive rheumatoid arthritis (RA) with methotrexate (16 mg/week), prednisone (2 mg every other day), and tacrolimus (3 mg/day), presented with a three-month history of neck pain, dysarthria, and dysphagia. Although his treatment options were limited due to an allergy to sulfasalazine and financial constraints, he was in remission with the treatment. Physical examination revealed no significant findings except for left hypoglossal nerve palsy, which manifested as atrophy of the left tongue musculature and deviation of the tongue toward the left side (Fig. 1C). Computed tomography of the cervical spine showed a widened atlantodental interval and vertical deviation of the axis (Fig. 1A). Additionally, the tip of the odontoid process was dislocated into the foramen magnum. Magnetic resonance imaging of the neck disclosed high-intensity areas in the C2 lesion, stenosis of the foramen magnum, and deformation of the dens (Fig. 1B). These findings were consistent with basilar impression, anterior and vertical atlantoaxial subluxation, and cervical myelopathy. After surgical fixation of the cervical spine, the neurological signs and symptoms were resolved (Fig. 1D). We concluded that basilar impression resulting from vertical atlantoaxial subluxation had compressed the left hypoglossal nerve on the surface of the brainstem, causing hypoglossal nerve palsy.
Metadata
Title
Hypoglossal nerve palsy due to basilar impression in rheumatoid arthritis
Authors
Tatsunori Shizuku
Noboru Hagino
Publication date
03-01-2024
Publisher
Springer International Publishing
Published in
Clinical Rheumatology / Issue 3/2024
Print ISSN: 0770-3198
Electronic ISSN: 1434-9949
DOI
https://doi.org/10.1007/s10067-023-06863-7

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