Alqahtani Saeed A, Agha Caroline, Rothstein Ted
National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA.
Department of Neurology, The School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA.
Am J Case Rep. 2016 Jul 26;17:535-7. doi: 10.12659/ajcr.897989.
BACKGROUND Isolated unilateral hypoglossal nerve injury is extremely rare. It may be caused by radiation therapy targeting neoplasms of the cephalic region. CASE REPORT A 51-year-old man with synovial sarcoma of the left upper arm status post extensive radiation therapy in 1980 presented in late 2014 with gradual onset of speech difficulty and difficulty moving his tongue for a couple of weeks. Neurological examination revealed isolated left-sided unilateral tongue atrophy. Postradiation residual extensive cicatrix with erythema over the whole left upper extremity extending to the neck on the affected side was noticed. On head magnetic resonance imaging (MRI) before and after administration of gadolinium, he was found to have asymmetrically fatty striations, atrophy, and fibrosis in the left tongue consistent with radiation toxicity. The patient's tongue weakness persisted without improvement. CONCLUSIONS The diagnosis of unilateral hypoglossal nerve injury is usually difficult. Detailed neurological examinations and thorough investigations including head MRI are very helpful. Previous exposure to radiation therapy is a potential cause of hypoglossal nerve injury. To our knowledge, this is the first case report that presents isolated unilateral tongue atrophy as a late complication of juxta cephalic radiation therapy.
孤立性单侧舌下神经损伤极为罕见。它可能由针对头颈部肿瘤的放射治疗引起。病例报告：一名51岁男性，1980年因左上臂滑膜肉瘤接受广泛放射治疗，2014年末出现渐进性言语困难及数周来舌运动困难。神经系统检查发现孤立性左侧单侧舌萎缩。注意到放疗后残留广泛瘢痕，整个左侧上肢包括患侧颈部出现红斑。在钆剂增强前后的头部磁共振成像（MRI）检查中，发现其左侧舌部存在不对称性脂肪条纹、萎缩及纤维化，符合放射毒性表现。患者的舌肌无力持续存在且无改善。结论：单侧舌下神经损伤的诊断通常较为困难。详细的神经系统检查以及包括头部MRI在内的全面检查非常有帮助。既往接受放射治疗是舌下神经损伤的一个潜在原因。据我们所知，这是首例将孤立性单侧舌萎缩作为头颈部放疗晚期并发症的病例报告。
