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Cervical and back pain
Last reviewed: 23.04.2024
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Cervical-lingual syndrome is a rare condition characterized by pain in the neck with numbness of the ipsilateral half of the tongue, which is strengthened when moving in the upper cervical spine.
It is suggested that this unusual combination of symptoms is due to compression of the C2-root by an abnormal atlantoaxial joint. This compression can be caused by joint instability, which makes it possible for lateral subluxation of the joint, bone pathology, such as fusion or stenosis, or tuberculosis infection. It is believed that the numbness of the tongue is caused by damage or intermittent compression of the afferent fibers of the tongue that pass in the sublingual nerve and innervate the tongue. A large number of fibers are proprioceptive, and pseudoathetosis of the tongue can be observed in patients with cervical-lingual syndrome. The most common cervical syndrome occurs in patients older than 50 years, although several cases have been reported in pediatric practice.
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Symptoms of Cervical Syndrome
Pain in the cervico-lingual syndrome is felt in the zone of innervation of the C2-rootlet. It is periodic, provoked by certain movements in the neck. Neurologic changes associated with pain are poorly expressed, in some patients there is a decrease in the volume of movements in the cervical spine or tenderness in the palpation of the upper parasthenic muscles. The most objective feature in the cervico-lingual syndrome is a decrease in sensitivity on the ipsilateral half of the tongue. Often there are pseudoathetotic movements of the tongue, caused by damage to proprioceptive fibers.
Examination
MRI of the brain and trunk should be conducted to all patients with suspected cervical-lingual syndrome. MRI is a highly reliable method that helps identify a serious pathology that includes tumors and demyelinating diseases. Magnetic resonance angiography can detect aneurysms that cause neurological symptoms. Patients who will not be born with an MRI (presence of pacemakers) are shown a CT scan. Clinical and laboratory studies, such as asak general blood test, blood biochemistry, ESR, are indicated for the exclusion of infection, temporal arteritis and oncological pathology, which can mimic cervical-lingual syndrome. Endoscopy of the laryngopharynx with examination of pear-shaped sinuses is indicated for the exclusion of latent malignancy. Selective C2-root blockade can confirm the diagnosis of cervical-lingual syndrome.
Differential diagnosis
Cervical-lingual syndrome is a clinical diagnosis, which can be put on the basis of targeted questioning and physical examination. Due to the rarity of this syndrome, the clinician should consider it as a diagnosis of exclusion. At the same time, eye, ear, nose, throat and tooth diseases can be disturbed, which can make diagnosis more difficult. Tumors of the laryngopharynx, including the pits of the tonsils and pear-shaped sinuses, can imitate pain in the cervical-lingual syndrome, as well as tumors of the bridge-cerebellar angle. Sometimes a demyelinating disease can cause symptoms identical to cervical-lingual syndrome. The "intermittent claudication" of the lower jaw, associated with temporal arteritis, as well as the neuralgia of the glossopharyngeal nerve, can sometimes confuse the clinical picture.
Treatment of cervical-lingual syndrome
Treatment of cervical-lingual syndrome should begin with an immobilization of the cervical spine with a soft collar. Next (it is recommended to select NSAIDs.) The possibility (blockade of the atlantoaxial joint and C2-rootlet should be considered, in the refractory cases, a spinal fusion of the upper cervical segments may be required.
Cervical-lingual syndrome is a unique and infrequent cause of neck pain. Pathognomonic for the syndrome is the numbness of the ipsilateral half of the tongue, unusual in character. Similar proprioceptive numbness is observed in patients with Bell's paralysis. Given the rarity of this painful condition, the clinician should carefully exclude other causes of the patient's symptoms before attributing them to the cervical-lingual syndrome.