Unilateral tongue atrophy as the initial clinical manifestation in a patient with prostate cancer

Key Clinical Message

Unilateral tongue atrophy can be a rare and crucial early indicator of metastatic prostate cancer, highlighting the need for vigilant monitoring in clinical assessments. This case underscores the importance of considering cranial nerve involvement, especially the twelfth, for timely intervention and comprehensive patient care.

Abstract

Prostate cancer, ranking among the most prevalent cancers, often manifests with skeletal metastases. Cranial nerve involvement, particularly the twelfth cranial nerve (XII), as an initial presentation is exceptionally rare. This case report outlines a unique instance of unilateral tongue atrophy as the primary clinical manifestation in a patient diagnosed with metastatic prostate cancer. A 54-year-old man presented with dysarthria and progressive weakness, later revealing signs of hypoglossal nerve paralysis, unilateral tongue atrophy, and skeletal metastases involving the base of the skull. Imaging studies, including CT and MRI, confirmed diffuse lytic lesions and cranial nerve entrapment. Further investigations identified elevated PSA levels, confirming acinar prostate adenocarcinoma. The patient underwent hormone therapy due to the poor prognosis. Prostate cancer's skeletal metastases are well-documented, but cranial nerve involvement remains rare, particularly with isolated XII nerve manifestation. The discussion emphasizes the diagnostic challenges, imaging techniques' roles, and the impact on prognosis and quality of life. This case underscores the rarity of unilateral XII nerve involvement as the initial presentation of metastatic prostate cancer. Clinicians should consider this manifestation, especially in men over 40, warranting a thorough diagnostic approach, including PSA measurement and referral for appropriate oncological and urological interventions.

Case report: Unilateral paralysis of the hypoglossal nerve as the only clinical sign of clivus meningioma - a case report and literature review

Introduction

Clivus meningiomas are benign tumors that occur at the skull base in the posterior cranial fossa. Symptoms usually progress several months or years before diagnosis and may include: headache, vertigo, hearing impairment, ataxia with gait disturbances, sensory problems. In the neurological findings, paralysis of the lower cranial nerves is most often seen, which in the later course can be accompanied by cerebellar and pyramidal signs until the development of a consciousness impairment.

Case presentation

We presented the case of a patient who at the time of diagnosis had only unilateral hypoglossal nerve paralysis with dysarthria and mild dysphagia. After the neurosurgical procedure, pathohistological analysis confirmed meningothelial meningioma.

Conclusion

Early recognition of clivus tumors, which include meningiomas, is necessary in order to implement an adequate therapeutic procedure and prevent further deterioration of the patient's condition.

Carotid Artery Dissection Induced Acute Tongue Swelling in a Cocaine User

Carotid artery dissection represents a well-recognized cause of hypoglossal nerve paralysis even if it is less known the cause of acute tongue swelling. We report a 42-year old men who presented to our observation with acute tongue swelling and atrophy of left side of tongue from a hypoglossal nerve injury. A magnetic resonance imaging revealed a denervation of the left half of the tongue from a hypoglossal nerve injury due to left extracranial internal carotid artery (ICA) dissection, without evidence of ischemic stroke. The urine toxicology screen test revealed a positivity for cocaine. This case report suggest to perform in young patient a toxicological drug screening test in presence of ICA dissection with hypoglossal nerve injury and an acute tongue swelling. However clinical data must be performed to validate this observation and to analyze the negative effect of cocaine use.

Hypoglossal nerve paralysis results in hypermetabolic activity on positron emission tomography/computed tomography in the contralateral tongue

False-positive results on combined positron emission tomography/computed tomography can complicate detection and surveillance of head and neck cancers. We present a rare case of false-positive contralateral [18F]-2-fluoro-2-deoxy-D-glucose tongue uptake after hypoglossal nerve paralysis caused by squamous cell carcinoma originating from the base of the tongue.

Wegener's disease presenting with occipital condyle syndrome

Tumors or chronic inflammatory lesions of the occipital condyle may cause occipital pain associated with an ipsilateral hypoglossal nerve injury (occipital condyle syndrome). We describe a young woman with recurrent otitis media and occipital condyle syndrome associated with a limited form of Wegener’s disease.