Tongue Atrophy From Brain-Stem Metastases

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Abstract
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

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