Cervicolingual syndrome and back pain

Cervicoglossal syndrome is a rare condition characterized by neck pain with numbness of the ipsilateral half of the tongue, which is aggravated by movement of the upper cervical spine.

This unusual combination of symptoms is thought to be due to compression of the C2 root by the abnormal atlantoaxial joint. This compression may be caused by joint instability, allowing lateral subluxations of the joint, by bony pathology such as fusion or stenosis, or by tuberculous infection. Numbness of the tongue is thought to be due to injury to or intermittent compression of the afferent fibers of the tongue, which travel within the hypoglossal nerve and innervate the tongue. Many of the fibers are proprioceptive, and pseudoathetosis of the tongue may be present in patients with cervicoglossal syndrome. Most commonly, cervicoglossal syndrome occurs in patients over 50 years of age, although a few pediatric cases have been reported.

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Symptoms of cervicoglossal syndrome

Pain in cervicoglossal syndrome is felt in the innervation zone of the C2 root. It is periodic, provoked by certain movements in the neck. Neurological changes associated with pain are weakly expressed, some patients experience a decrease in the range of motion in the cervical spine or pain when palpating the upper paraspinous muscles. The most objective sign of cervicoglossal syndrome is decreased sensitivity in the ipsilateral half of the tongue. Pseudo-athetotic movements of the tongue are often observed, caused by damage to the proprioceptive fibers.

Survey

MRI of the brain and brainstem should be performed in all patients with suspected cervicoglossal syndrome. MRI is a highly reliable method that helps identify serious pathology, including tumors and demyelinating diseases. Magnetic resonance angiography can detect aneurysms causing neurological symptoms. Patients who cannot undergo MRI (the presence of pacemakers) are shown computed tomography. Clinical and laboratory studies, such as complete blood count, blood biochemistry, ESR, are indicated to exclude infection, temporal arteritis and oncological pathology that can imitate cervicoglossal syndrome. Endoscopy of the laryngopharynx with examination of the pyriform sinuses is indicated to exclude hidden malignancy. Selective C2-root block can confirm the diagnosis of cervicoglossal syndrome.

Differential diagnosis

Cervicoglossal syndrome is a clinical diagnosis that can be made on the basis of a careful history and physical examination. Because of the rarity of this syndrome, the clinician should consider it a diagnosis of exclusion. Concurrent eye, ear, nose, throat, and dental disease may complicate the diagnosis. Tumors of the hypopharynx, including the tonsillar pits and pyriform sinuses, may mimic the pain of cervicoglossal syndrome, as may tumors of the cerebellopontine angle. Occasionally, a demyelinating disorder may cause symptoms identical to cervicoglossal syndrome. "Intermittent claudication" of the mandible associated with temporal arteritis may occasionally confuse the clinical picture, as may glossopharyngeal neuralgia.

Treatment of cervicoglossal syndrome

Treatment of cervicoglossal syndrome should begin with immobilization of the cervical spine with a soft collar. Then (selection of NSAIDs is recommended. The possibility of (blockade of the atlantoaxial joint and C2 root) should be considered. In refractory cases, spondylodesis of the upper cervical segments may be required.

Cervicoglossal syndrome is a unique and uncommon cause of neck pain. The syndrome is characterized by numbness of the ipsilateral half of the tongue, which is unusual in character. Similar proprioceptive numbness is seen in patients with Bell's palsy. Given the rarity of this painful condition, the clinician must carefully exclude other causes of the patient's symptoms before attributing them to cervicoglossal syndrome.