Neurology病例:颅底脑膜瘤所致的孤立性单侧舌下神经麻痹

2022-08-11 神经科病例撷英拾粹 神经科病例撷英拾粹

颅底脑膜瘤所致的孤立性单侧舌下神经麻痹病例分享。

73岁女性,表现为间歇性口齿不清、流口水和误吸6个月。初步评估显示右半侧舌萎缩(图1)伴同侧肌束颤动和无力。余神经系统查体无异常。脑MRI证实继发于舌下神经管脑膜瘤压迫的右侧舌下神经麻痹(HNP),伴典型的放射学表现(图2)

孤立性HNP罕见的,通常提示肿瘤转移或为特发性。其他原因包括局部动静脉瘘、Chiari畸形和后颅窝手术或颈动脉内膜切除术的医源性损伤。良性脑膜瘤很少引起孤立性HNP,但典型的放射学表现可以明确诊断并避免活检。

(图1:A:患者照片显示伸舌右偏和萎缩;B:2016年冠状位FLAIR;可见右半侧舌异常高信号,提示右侧舌下神经损害导致的脂肪浸润[红箭])

(图2:A:2016年的轴位T2WI可见右下枕骨大孔内异常轻度T2高信号软组织[红箭],并延伸至舌下管[虚线箭];B-C:3年后复查MRI:分别为轴位和冠状位增强T1 SPACE;可见右侧枕骨大孔和舌下管脑膜瘤的间距增大,现在邻接下延髓和上颈髓[红箭];D:重建冠状位颅内CT:血管造影[骨窗]可见舌下管口右侧枕骨大孔内轻微的右侧骨肥大,为脑膜瘤的典型表现;本例排除了动脉瘤病因[未放图])

[参考文献]

Coenen J, Cleaver J, James R, Chohan G. Teaching NeuroImage: Isolated Unilateral Hypoglossal Nerve Palsy due to Skull Base Meningioma. Neurology. 2021 Oct 19;97(16):e1639-e1640. 

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    2022-11-29 yinhl1978
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    2022-08-06 jxrzshh