Pandey Rohit, Bhayana Himanshu, Dhammi Ish Kumar, Jain Anil Kumar
Department of Orthopedics, UCMS and GTB Hospital, New Delhi, India.
Indian J Orthop. 2019 Jan-Feb;53(1):204-207. doi: 10.4103/ortho.IJOrtho_600_17.
Reporting a rare scenario of hypoglossal nerve palsy in craniovertebral tuberculosis. Two patients presented in outpatient department with chief complaints of pain in neck, restricted neck movements, gait changes, difficulty in speech and weakness in all the extremities. On the basis of clinicoradiological correlation, the patients were diagnosedwithtuberculosis of C1-C2 spine. They were started on antituberculosis therapy Category 1. The patients improved clinically and there was no worsening of symptoms, but they noticed tongue deviation and hypotrophy on one side of the tongue. C1-C2 tuberculosis along with cranial nerve palsy, especially hypoglossal nerve is one of the rarest presentations. Hypoglossal nerve arises from the medulla, exits through hypoglossal canal in the base of the skull and traverses neck to supply tongue musculature. Prevertebral fascia extends from superior mediastinum to base of the skull. Abscess in this area can cause either actual compression of the hypoglossal canal or C1 and base of the skull dissociation which can lead to compression of the canal.
报告颅颈结核中罕见的舌下神经麻痹病例。两名患者在门诊就诊，主要症状为颈部疼痛、颈部活动受限、步态改变、言语困难和四肢无力。根据临床与影像学相关性，患者被诊断为C1-C2脊柱结核。他们开始接受1类抗结核治疗。患者临床症状改善，症状未加重，但他们注意到舌头偏向一侧且一侧舌头萎缩。C1-C2结核伴脑神经麻痹，尤其是舌下神经麻痹，是最罕见的表现之一。舌下神经发自延髓，通过颅底的舌下神经管穿出，穿过颈部以供应舌肌。椎前筋膜从纵隔上部延伸至颅底。该区域的脓肿可导致舌下神经管实际受压，或C1与颅底分离，进而导致神经管受压。
