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LETTER TO EDITOR
Year : 2015  |  Volume : 63  |  Issue : 5  |  Page : 782-783

Tapia's syndrome secondary to metastatic prostate cancer


1 Department of Neurology, Derince Education and Research Hospital, Derince, Kocaeli, Turkey
2 Department of Radiology, Derince Education and Research Hospital, Derince, Kocaeli, Turkey
3 Department of Physical Medicine and Rehabilitation, Derince Education and Research Hospital, Derince, Kocaeli, Turkey

Date of Web Publication6-Oct-2015

Correspondence Address:
Gokhan Duygulu
Department of Radiology, Derince Education and Research Hospital, Derince, Kocaeli
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.166531

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How to cite this article:
Yilmaz Z, Duygulu G, Kiliç S, Terzi R. Tapia's syndrome secondary to metastatic prostate cancer. Neurol India 2015;63:782-3

How to cite this URL:
Yilmaz Z, Duygulu G, Kiliç S, Terzi R. Tapia's syndrome secondary to metastatic prostate cancer. Neurol India [serial online] 2015 [cited 2019 Oct 15];63:782-3. Available from: http://www.neurologyindia.com/text.asp?2015/63/5/782/166531


Sir,

A concurrent extra-cranial involvement of the recurrent laryngeal and the hypoglossal nerves is known as Tapia's syndrome, which was first described in 1904 by Garcia Tapia.[1] Symptoms include ipsilateral paralysis of the vocal cords and tongue. Hoarseness, dysphagia, dysarthria, and dyspnea may develop depending upon the level of involvement of these nerves. Although rare, it can complicate general anesthesia with endotracheal intubation. Tumors, trauma, and surgery are among the rare causes of Tapia's syndrome. We report a case of Tapia's syndrome developing due to the presence of skull base metastasis of prostate cancer.

A 61-year-old male patient was referred to us with complaints of dysphagia and hoarseness that was present for the last 2 weeks. The patient's medical history did not include any specific features, except for essential hypertension. The neurological examination showed atrophy and fasciculation in the right half of the tongue. The tongue was deviated to the right due to the involvement of the right hypoglossal nerve [Figure 1]. The ear-nose-throat examination revealed a right vocal cord paresis. The remaining cranial nerve and neurological examination were normal. The routine hemogram and biochemical blood analysis were normal.
Figure 1: Neurological examination of the case showed that the patient's tongue was deviated towards the right side

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Computed tomography (CT) scan of the temporal bone showed a lytic destructive lesion involving the right half of the occipital bone at the level of the foramen magnum and the right half of the C1 vertebra and clivus, extending to the hypoglossal canal [Figure 2]. Contrast enhanced cranial magnetic resonance imaging (MRI) revealed no parenchymal-leptomeningeal metastases. However, mass lesions (sclerotic bone metastases) with enhanced contrast uptake were observed in postcontrast sections. On T1 weighted sequence, the lesions were hypointense and on the T2 weighted sequence, they were hyperintense, and caused bony expansion of the midline occipital bone, left parietal and right temporal bones, and the right half of the clivus at the level of foramen magnum. MRI of the neck showed a multiloculated and multi-lobulated mass lesion measured 64 mm × 56 mm, with a heterogeneous contrast uptake at the level of the right hypoglossal canal [Figure 3]. The cervical MRI showed extensive and numerous mass lesions (sclerotic bone metastases) in the cervical vertebrae, which had peripheral contrast uptake in the postcontrast sections. Those lesions were hypointense on both T1 and T2 sequences.
Figure 2: Computed tomography examination of the skull base showed findings of metastasis involving the occipital condyle, right half of the clivus, and the hypoglossal canal

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Figure 3: Contrast-enhanced T1-weighted image shows the heterogeneous mass lesion with contrast uptake located at the right hypoglossal canal

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The total prostate-specific antigen (PSA) level was above 10,556.45 ng/mL. Prostate biopsy confirmed the diagnosis of adenocarcinoma. The Gleason score was 8. Radiotherapy was planned for the patient.

Tapia's syndrome is characterized by palsy of the recurrent laryngeal and hypoglossal nerves, which affects the ipsilateral vocal cord and tongue. Some cases of anesthesia-related Tapia's syndrome have been reported. Most of these patients have had an orotracheal intubation.[2] Tapia's syndrome frequently develops due to neuropathy caused by pressure applied by the endotracheal tube on the vagus and hypoglossal nerves.[3],[1] In the case of Tapia's syndrome developing after posterior cervical spine surgery, in addition to the pressure applied by the endotracheal tube, nerve stretching during excessive anterior and lateral flexion of the head has also been suggested as a causative factor.[4],[3] Most patients with this syndrome make a complete recovery within several months. The treatment is usually supportive, with or without a short course of systemic corticosteroids, depending on the extent of the nerve damage.[2]

Tapia's syndrome associated with a neoplastic or an infective etiology may rarely be encountered.[2] Although rare, cases with metastatic prostate cancer with isolated involvement of the hypoglossal nerve have been reported in the literature,[5],[6] Cranial neuropathy, as the presenting feature, is extremely rare. The case presented here was accompanied by concurrent involvement of the hypoglossal and recurrent laryngeal nerves, due to the expansion of the metastasis to the hypoglossal canal and the paratracheal region.

Prostate cancer commonly metastasizes to the skeletal system and to the lymph nodes. A majority of the skeletal system metastases are seen in the vertebrae, pelvis and femoral bones.[5] Skull base involvement is rare. Although rare, cranial nerve paralysis can be encountered in advanced prostatic, breast and lung cancers as well as lymphoma.[4],[5] In the present case, we observed extensive sclerotic bony metastases. Based on increased PSA levels and the results of prostate biopsy, the patient was diagnosed as having adenocarcinoma of the prostate gland.

Multiple or isolated cranial nerve involvement may often occur in prostatic cancer in middle-aged or elderly males with bony metastases. CT and MRI are useful for detection of skull base metastasis in these cases.

(Written informed consent was obtained from the patient for publication of this report and the accompanying images).

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
 » References Top

1.
Tesei F, Poveda LM, Strali W, Tosi L, Magnani G, Farneti G. Unilateral laryngeal and hypoglossal paralysis (Tapia's syndrome) following rhinoplasty in general anaesthesia: Case report and review of the literature. Acta Otorhinolaryngol Ital 2006;26:219-21.  Back to cited text no. 1
    
2.
Park CK, Lee DC, Park CJ, Hwang JH. Tapia's syndrome after posterior cervical spine surgery under general anesthesia. J Korean Neurosurg Soc 2013;54:423-5.  Back to cited text no. 2
    
3.
Gevorgyan A, Nedzelski JM. A late recognition of Tapia syndrome: A case report and literature review. Laryngoscope 2013;123:2423-7.  Back to cited text no. 3
    
4.
Cantalupo G, Spagnoli C, Cerasti D, Piccolo B, Crisi G, Pisani F. Tapia's syndrome secondary to laterocervical localization of diffuse large cell lymphoma. Brain Dev 2014;36:548-50.  Back to cited text no. 4
    
5.
Abdullah Z, Darrad M, Pathak S. Atrophy of the tongue as the presenting feature of metastatic prostate cancer. Int Neurourol J 2011;15:176-8.  Back to cited text no. 5
    
6.
Kimura M, Satoh T, Fujita T, Matsumoto K, Nishi M, Iwamura M, et al. Cranial nerve palsies due to skull base metastases in patients with prostate cancer: A report of two cases. Nihon Hinyokika Gakkai Zasshi 2006;97:748-51.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]

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