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James R. Keane, MD

Arch Neurol. 1984;41(11):1219-1220.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

Progressive bilateral tongue atrophy suggests motor neuron disease. Other considerations might include poliomyelitis in endemic areas, syringobulbia, and tumors of the clivus (chordoma) or within the neck (nasopharyngeal carcinoma). Rare causes of progressive bulbar palsy include familial degenerative diseases¹ and bony abnormalities involving the hypoglossal canals.

In patients with known cancer, spread of tumor to the meninges would be the likely cause of tongue atrophy,^2,3 remote possibilities being tumor involvement of the cervical lymph nodes, radiation rhombencephalitis,⁴ or paraneoplastic brain-stem encephalitis. In the following two patients, solitary intramedullary metastases to the dorsal pontomedullary tegmentum caused progressive bilateral 12th-nerve palsies with a paucity of long-tract signs.

REPORT OF CASES

Case 1.

—Six months after a diagnosis was established of infiltrating ductal carcinoma of the left breast with multiple bony metastases, a 57-year-old woman began to have trouble speaking clearly. In addition, she noted that it took extra efforts with . . . [Full Text PDF of this Article]

Author Affiliations
From the Department of Neurology, Los Angeles County—University of Southern California Medical Center, Los Angeles.

Footnotes
Accepted for publication Dec 15, 1983.

Reprint requests to 1200 N State St, Los Angeles, CA 90033 (Dr Keane).

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