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Neurogenic tongue swelling from skull base tumour: bulk without strength
  1. Afa Ibrahim1,
  2. Athanasios Papathanasiou1,
  3. Adam G Thomas2,
  4. Farhan Malik1,
  5. Christopher Fox3,4,
  6. Emily Chernucha4,
  7. Christopher Martin Allen1,5,
  8. Radu Tanasescu1,5
  1. 1Department of Neurology, QMC, Nottingham University Hospitals NHS Trust, Nottingham Centre for Multiple Sclerosis and Neuroinflammation, Nottingham, UK
  2. 2Department of Neuroradiology, QMC, Nottingham University Hospitals NHS Trust, Nottingham, UK
  3. 3School of Medicine, University of Nottingham, Nottingham, UK
  4. 4Department of Haematology, Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
  5. 5Mental Health and Clinical Neuroscience Academic Unit, University of Nottingham, School of Medicine, Nottingham, Nottingham, UK
  1. Correspondence to Dr Radu Tanasescu; radu.tanasescu{at}nottingham.ac.uk

https://doi.org/10.1136/pn-2024-004444

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    A 49-year-old man reported 3 months of left-sided tongue swelling and dysarthria, with perceived impaired control of the tongue and mild headache. He had no weight loss, shortness of breath or other systemic symptoms. He was in remission from ATM-deleted chronic lymphocytic leukaemia following treatment with acalabrutinib. He also had neurosarcoidosis, again in remission. On examination, there was hemihypertrophy of the left side of the tongue with ipsilateral deviation and weakness, but no tongue fasciculation or other neurological signs (figure 1). He did not undergo electromyography.

    Figure 1

    Tongue protrusion showing left-sided tongue swelling with deviation towards the left, consistent with left hypoglossal nerve palsy.

    MRI showed his tongue musculature had a normal signal intensity, with no evidence of fat infiltration or oedema (figure 2A). MR scan of the brain identified an infiltrating mass in the left basi-occiput and occipital condyle with narrowing of the left hypoglossal canal. PET-CT scan confirmed that this area was metabolically active (figure 3) and a biopsy confirmed a low-grade B-cell lymphoma with plasmacytic differentiation, with no features of sarcoidosis.

    Figure 2

    (A) MRI at diagnosis (1 June 2022). Coronal T2 fat-saturated (a), T1 (b) and axial reconstructed T1 fat-saturated volume postcontrast (c) images …

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    Footnotes

    • X @afaibrahim3

    • Contributors RT led the clinical neurological management of the case, undertook the literature review, originated the concept for this report and obtained the clinical images from the patient. RT, AGT, CMA, AP, CF and EM were involved in the care of the patient. AGT undertook imaging perusal, reporting and review and created the figures of the tongue MRI images. AI undertook the literature review and was primarily responsible for drafting the manuscript. FM undertook literature review and obtained informed consent from the patient. CF, EC, CMA, AP and AGT contributed with the investigation and diagnostic workup. All authors provided critical revision of the manuscript. RT acts as a guarantor.

    • Funding RT received support from UKRI MRC (CARP MR/T024402/1).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned. Externally peer reviewed by Tom Hughes, Cardiff, UK.