13.5 Neck-tongue syndrome

Identification: Male patient, 22 years old, with acute episodes of cervical and lingual pain for 3 months.

History of Present Illness: Symptoms: Pain: Location: Unilateral occipital/suboccipital region (left) Ipsilateral half of the tongue Characteristic: Sudden paroxysms (seconds to 2 minutes) Intensity 8-9/10 (VAS) Frequency: 3-10 episodes/day Triggers: Abrupt cervical rotation (especially to the contralateral side) Neck hyperextension Associated Signs: Transient lingual paresthesia Mild lingual edema during crises Post-crisis cervical functional limitation

Relevant History: Cervical trauma during sports practice (martial arts) 4 months ago No history of primary headaches

Physical/Neurological Examination: Cervical Assessment: Pain reproduced with forced contralateral rotation (positive modified Spurling test) Ipsilateral C1-C2 hypomobility Tongue Examination: Transient asymmetry during crises (due to genioglossus muscle paresis) Lingual papillae preserved General Examination: Gag reflex present No motor or sensory deficits

Complementary Exams: Dynamic MRI of the Upper Cervical Spine: Mild atlantoaxial instability (increased anterior atlanto-dental space in flexion) No medullary compression Vertebral Angio-MRI: Reduced flow in the left vertebral artery during contralateral rotation Tongue Electromyography: Acute denervation potentials in the left hemi-tongue during crises