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Case Reports
. 2018 Oct;8(4):188-190.
doi: 10.1177/1941874418755952. Epub 2018 Feb 13.

Skull Base Metastasis Revealed by Bone Scintigraphy in a Patient With Hypoglossal Nerve Palsy

Aristeidis H Katsanos  1 , Chrissa Sioka  2   3 , Maria Chondrogiorgi  1 , Athanasios Papadopoulos  4 , Andreas Fotopoulos  2 , Athanassios P Kyritsis  1   3 , Vasileios Ragos  5
Affiliations
Case Reports

Skull Base Metastasis Revealed by Bone Scintigraphy in a Patient With Hypoglossal Nerve Palsy

Aristeidis H Katsanos et al. Neurohospitalist. 2018 Oct.

Abstract

Even though different imaging modalities are available in sole or in combination for the optimal detection of bone metastases, whole-body bone scintigraphy (BS) in a single session seems to be advantageous. We present an 80-year-old male with unilateral left hypoglossal nerve palsy (HNP) and no other focal deficits on neurological examination. Initial brain computed tomography (CT) scan revealed no pathological findings, while the subsequent cranial CT and magnetic resonance imaging (MRI) scans uncovered only mild nonspecific sclerotic lesions in left occipital condyle. All laboratory examinations were within normal limits, except for an elevated alkaline phosphatase (170 U/L) and a markedly increased prostate-specific antigen (609 ng/mL). The patient underwent whole-body BS with technetium-99m that revealed increased radiotracer deposition compatible with metastases in multiple foci, including the left occipital condyle. Prostate biopsy confirmed the diagnosis of prostate adenocarcinoma. Our case suggests that a complete and thorough workup for hidden malignancies should be performed in all patients with HNP, even in the absence of a finding in brain neuroimaging. Bone scintigraphy is an essential investigation that should be considered in uncertain cases of HNP, and especially in those with negative CT and MRI scans.

Keywords: bone scintigraphy; hypoglossal nerve palsy; occipital condyle; skull base metastasis.

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Conflict of interest statement

Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Mild nonspecific sclerotic lesions (arrows) in left occipital condyle present in (A) cranial computed tomography (CT) scan, (B) T1-magnetic resonance imaging (MRI), and (C) T1-MRI sequences with gadolinium enhancement.
Figure 2.
Figure 2.
Increased radiotracer deposition in the left occipital condyle (arrows) and other multiple foci in bone scintigraphy with technetium-99m.
See this image and copyright information in PMC

References

    1. Heindel W, Gübitz R, Vieth V, Weckesser M, Schober O, Schäfers M. The diagnostic imaging of bone metastases. Dtsch Arztebl Int. 2014;111(44):741–747. - PMC - PubMed
    1. Boban M, Brinar VV, Habek M, Rados M. Isolated hypoglossal nerve palsy: a diagnostic challenge. Eur Neurol. 2007;58(3):177–181. - PubMed
    1. Rué M, Jecko V, Dautheribes M, Vignes JR. Delayed hypoglossal nerve palsy following unnoticed occipital condyle fracture. Neurochirurgie. 2013;59(6):221–223. - PubMed
    1. Su TM, Lui CC, Cheng MH, Tsai SC. Occipital condyle fracture with hypoglossal nerve palsy: case report. J Trauma. 2000;49(6):1144–1146. - PubMed
    1. Demisch S, Lindner A, Beck R, Zierz S. The forgotten condyle: delayed hypoglossal nerve palsy caused by fracture of the occipital condyle. Clin Neurol Neurosurg. 1998;100(1):44–45. - PubMed

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