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| LETTERS TO EDITOR |
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| Year : 2013 | Volume
: 61
| Issue : 3 | Page : 324-325 |
Hypoglossal schwannoma presenting as hemi-atrophy of the tongue
Pushpraj S Baghel1, Avinash Gupta1, Vishwa Deepak Tripathi2, Donapati Sunil Reddy2
1 Department of Pathology, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
2 Department of Medicine, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
| Date of Submission | 05-Feb-2012 |
| Date of Decision | 11-Feb-2013 |
| Date of Acceptance | 09-Mar-2013 |
| Date of Web Publication | 16-Jul-2013 |
Correspondence Address:
Pushpraj S Baghel
Department of Pathology, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0028-3886.115092
How to cite this article:
Baghel PS, Gupta A, Tripathi VD, Reddy DS. Hypoglossal schwannoma presenting as hemi-atrophy of the tongue. Neurol India 2013;61:324-5 |
Sir,
Schwannoma of the hypoglossal nerve is exceedingly infrequent. [1],[2] Because of their rarity, early diagnosis of these lesions is intricate.
A 40-year-old man presented with slowly progressive slurring of speech and impairment of tongue mobility. He first noticed these symptoms 6 months back, together with slurred speech. There was no other relevant neurologic history. On neurological examination, he had dysarthria mainly for linguals. There was tongue deviation to the left side with hemi-atrophy of the tongue [Figure 1]. Rest of the neurological examination was essentially normal. Computed tomography (CT) scan of the neck showed mass in the left cerebellopontine angle and left parapharyngeal area. Magnetic resonance imaging (MRI) brain with contrast showed a mass arising from 12 th cranial nerve involving with intra cranial and extra foraminal extension [Figure 2]. On left retro mastoid sub-cortical craniotomy, there was a soft tumor within the enlarged left hypoglossal foramen. Histopathology of the tumor was schwannoma [Figure 3]. | Figure 1: Deviation of the tongue to left on protrusion with left sided hemi-atrophy of the tongue
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 | Figure 2: Brain MRI showing mass arising from left hypoglossal nerve in jugular foramen
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 | Figure 3: Histopathological study of the excised mass consistent with a schwannoma
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Schwannoma accounts for 9% of all intracranial tumors and most commonly involves the 8 th cranial nerve. The leading symptoms of the hypoglossal schwannoma include headache and dizziness. High resolution CT scan of the posterior fossa with bony details of the foramen passing through is the neurodiagnostic procedure of choice. Histologically, Antoni type A schwannoma has elongated spindle cells in irregular streams and is compact in nature and type B schwannoma has a looser organization often with cystic spaces. Most of the hypoglossal schwannoma have a dumbbell shape and involve both intracranial and extracranial segment of the hypoglossal nerve. [3] However, pure intracranial hypoglossal schwannoma are unusual. [1] The most distinguishing clinical findings of patients with hypoglossal nerve schwannoma are unilateral tongue atrophy and fasciculations. [4] The differential diagnosis of tumor involving hypoglossal canal includes chemodectoma, chordoma, meningioma, lymphoma, and metastatic tumors. The symptom of slurred speech improved after the surgery. Hypoglossal neuropathy is frequently associated with adjacent cranial nerve involvement. Isolate hypoglossal neuropathy is rare. Tumor, infection, trauma of skull base, radiation, and vascular insult are the causes of isolated hypoglossal nerve palsy. [5] In conclusion, schwannoma of the hypoglossal nerve is very rare, can present with atrophy of the tongue, but they can also be asymptomatic initially. [5] Early diagnosis and surgical intervention can preserve the function of nerve.
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| 2. | Takahashi T, Tominaga T, Sato Y, Watanabe M, Yoshimoto T. Hypoglossal neurinoma presenting with intratumoral hemorrhage. J Clin Neurosci 2002;9:716-9.
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| 3. | Jia G, Wang Z, Zhang J. Diagnosis and treatment of hypoglossal neurinoma. Zhonghua Yi Xue Za Zhi 2001;81:1264-5.
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| 4. | Chang KC, Leu YS. Hypoglossal schwannoma in the submandibular space. J Laryngol Otol 2002;116:63-4.
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| 5. | Passacantilli E, Lanzino G, Henn JS, Partovi S, Spetzler RF. Intracranial extradural schwannoma of the 12 th cranial nerve. J Neurosurg 2003;98:219.
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[Figure 1], [Figure 2], [Figure 3]
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