Lung carcinoma representing initially with subacute bilateral isolated hypoglossal nerve palsy: A case of atypical occipital condyle syndrome

Abstract

We herein report the case of a 73-year-old man presenting bilateral hypoglossal nerve palsy as the initial symptom of metastatic lung cancer. The patient had subacute dysarthria and dysphagia caused by a disturbance in the protrusion of his tongue; He also had severe constant occipital pain, which prevented sleep. MRI showed a mass with contrast enhancement at the skull base. Squamous cell carcinoma was shown by bronchoscopic lung biopsy. In cases of hypoglossal nerve palsy with preceding severe ipsilateral occipital pain, metastatic cancer to the skull base should be considered as occipital condyle syndrome, even though the hypoglossal nerve palsy is bilateral or the patient has no history of malignant tumors. Occipital condyle syndrome with bilateral hypoglossal paralysis may be important as a sign of poor prognosis in cancer.