Skull base metastasis - tongue swelling

Case contributed by Eid Kakish
Diagnosis certain


History of right breast cancer, presenting with tongue swelling and dysarthria. She also complains of bilateral upper limb pain and numbness. Clinical exam revealed left-sided tongue deviation, as well as decreased tone and power in both upper limbs.

Patient Data

Age: 60 years
Gender: Female

Extensive abnormal signal alteration involving the inner table of the left parietal and right frontal bones, the clivus and basiocciput with associated expansion of the left side of the basiocciput, particularly the left jugular tubercle and occipital condyle, corresponding to a heterogeneous pattern of enhancement on postcontrast images with restricted diffusion on DWI, resulting in narrowing of the left hypoglossal canal with secondary involvement of the left hypoglossal nerve.

Heterogeneous enhancement and swelling involving the left hemitongue, with associated obliteration of the left vallecula and median glossoepiglottic fold.

Multiple metastatic expansile lytic calvarial and skull base lesions.

Expansion and destruction of the left occipital condyle and jugular tubercle with extension into the left hypoglossal canal.

Cervical spine


Multiple metastatic bony lesions involving almost all cervical vertebral bodies with posterior element extension, larger in C5, C6 and C7, with obliteration of the left neural foramina and resultant exiting nerve root compression at these levels.

Case Discussion

MR findings of left hypoglossal nerve palsy secondary to a large expansile lytic metastatic mass involving the basiocciput, particularly the left occipital condyle, jugular tubercle and hypoglossal canal with resultant canal narrowing and secondary involvement of the left hypoglossal nerve.

Multiple other metastatic osteolytic lesions are seen involving the inner tables of the left parietal and right frontal bone. Extensive lytic metastatic disease is seen involving the clivus.

Cervical spine metastatic bony lesions with posterior element involvement with associated obliteration of multilevel neural foramina and secondary exiting nerve root compression.

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