A 71-YEAR-OLD FEMALE WITH MULTIPLE CRANIAL NERVE PALSIES

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Presentation transcript:

A 71-YEAR-OLD FEMALE WITH MULTIPLE CRANIAL NERVE PALSIES Teaching NeuroImages Neurology Resident and Fellow Section © 2016 American Academy of Neurology

Vignette a 71-year-old female with juvenile-onset rheumatoid arthritis presented with right trigeminal mandibular pain and dysphonia on a background of 6-months oropharyngeal dysphagia and C3-C5 laminectomy in 2010 she had severe deforming polyarthropathy neurological examination revealed bilateral tongue wasting, loss of tongue protrusion and right vocal cord paresis uvula movement, pharyngeal and facial sensation were normal Weerasinghe et al © 2016 American Academy of Neurology

Imaging A B Post-contrast axial (A) and coronal (B) T1-weighted MRI brain demonstrating a large, non- enhancing atlantoaxial pannus (arrows) encroaching bilateral hypoglossal canals and extending along the skull base Weerasinghe et al © 2016 American Academy of Neurology

Rheumatoid pannus of the cervical spine: An unusual cause of multiple cranial nerve palsies multiple cranial neuropathies are extremely rare in rheumatoid arthritis (1, 2) and should raise suspicion of cervical spine pannus aggressive disease-modifying medical therapy may obviate need for neurosurgery (1) References 1. Mathew R, Mumford CJ, Daroszewska A. Unilateral glossopharyngeal and hypoglossal nerve palsies due to compression by a rheumatoid pannus. Rheumatology 2010 Oct;49(10):1996-7. 2. Zeina AR, Nachtigal A, Ayshovich N, Rosner I, Rozenbaum M. Hypoglossal nerve palsy secondary to cervical spine involvement in rheumatoid arthritis: clinical and radiological features. Joint Bone Spine. 2009 Oct;76(5):547-9. Weerasinghe et al © 2016 American Academy of Neurology