Isolated Hypoglossal nerve palsy due to amyloid cervical arthropathy in long term hemodialysis.

摘要

Sirs: Isolated peripheral hypoglossal nerve palsy is rare and it is caused by primary or secondary tumors of the skull base, leptomeningeal metastases, trauma, carotid artery dissection, surgery or aneurysms of the carotid artery, dural arteriovenous fistula, Chiari malformation, otorhinolaryngo-logical and anesthesiological procedures, radiation, infectious diseases (borreliosis, mononucleosis) and rarely an anomalous vertebral artery course .To our knowledge we report the first case of Xllth nerve palsy due to compression by uremic arthropathy.A 69 year-old woman was admitted for a subacute onset of a continuous stabbing pain of the right cervical and occipital regions, associated with difficulty in moving her tongue and in articulating words. Neurological examination showed only mild dysarthria and right hypoglossal nerve palsy, with right hemiatrophy of the tongue (Fig. 1). The patient had required of hemodialytic treatment beginning 14 years ago because of end-stage renal disease secondary to non-steroidal antinflammatory drugs abuse for migraine, and, since then, she had undergone four surgical interventions for total hip arthroplasty and also for bilateral carpal tunnel syndrome. Brain CT was normal, Doppler ultrasound and MR angiography of supraortic vessels excluded the presence of carotid artery dissection.