J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.47.7.751 on 1 July 1984. Downloaded from Letters 751 neck-abdominal reflex, and seems to indi- who developed unilateral numbness in the fibres from the tongue and concluded that cate severe brainstem damage, and hence a neck and tongue of spinal origin. they pass via the ansa hypoglossi to the C2 poor prognosis. A 35-year-old woman developed symp- dorsal roots. The pathway of the afferents toms of acute transverse myelopathy in the from the tongue after entering the central H SHIBASAKI upper thoracic spinal cord at the age of 23 nervous system was little discussed. Bow- M NAKASHIMA * years. After recovery, she had eight similar man and Combs4 showed that the hypo- R NESHIGE exacerbations and remissions during the glossal afferents in the rhesus monkey pro- T KITAMOTO following ten years. Myelography at the ject rostally in the ipsilateral dorsal R KAKIGI age of 28 years was normal. At the age of funiculus via the dorsal root ganglia of the Y KURODA 33, she became unable to walk owing to C2 and/ or C3 nerve. It seems reasonable The Division ofNeurology, paraplegia and was confined to a wheel- to postulate that a similar situation obtains Department of Internal Medicine, chair. At the age of 35, weakness of the left in humans. The numbness in the neck and and Department ofAnesthesiology, * upper limb developed acutely. Neurologi- tongue may be explained by involvement Saga Medical School, Nabeshima, cal examination on admission revealed of the dorsal funiculus during the tonic Saga City, 840-01, Japan positive Lhermitte sign and paraesthesia on seizures. However, an alternative explana- the left between C2 and C3 segment. tion may be possible. Sensory fibres of the References Marked weakness with hypereflexia was mandibular branch are distributed to the noted in the left upper limb. Joint position tongue and descend in the brainstem as the 'Editorial. Brain death. Lancet 1981;i:363-5. 2 Guidelines for the determination of death: sense of the left upper limb was severely spinal trigeminal tract. They terminate at Report of the medical consultants on the impaired. There were motor and sensory medullary level or extend into upper cervi- diagnosis of death to the president's com- deficits due to transverse thoracic cal spinal segments.56 Disturbance of this mission for the study of ethical problems in myelopathy which persisted since the age tract may cause the numbness in the medicine and biomedical and behavioral of 33 years. Laboratory examinations were tongue. research. Neurology (NY) 1982;32:395-9. normal except for a mild pleocytosis in the SHOSAKU NODA Plum F, Posner JB. Diagnosis of Stupor and spinal fluid. An EEG and a CT scan were HIROTOSHI UMEZAKI Coma. Philadelphia: FA Davis, 1969. negative. Department ofNeurology, Becker DP, Robert CM Jr, Nelson JR, Stern Tonic seizures appeared after the signs Kyushu-Kosei-Nenkin Hospital, WE. An evaluation of the definition of Protected by copyright. cerebral death. Neurology (Minneap) and symptoms of the neck and left upper Yahata-Nishiku, Kitakyushu 806, Japan 1970;20:459-62. limb had subsided considerably. Voluntary J0rgensen EO. Spinal man after brain death. movement of the left arm provoked tingl- References The unilateral extension-pronation reflex of ing sensation in the left hand, which radi- the upper limb as an indication of brain ated to the shoulder. Simultaneously the 'Lance JW, Anthony M. Neck-tongue syn- death. Acta Neurochir 1973;28:259-73. spasm appeared in the left upper limb, with drome on sudden turning of the head. J 6 Ivan LP. Spinal reflexes in cerebral death. fingers flexed, wrist and elbow flexed and Neurol Neurosurg Psychiatry 1980;43:97- Neurology (Minneap) 1973;23:650-2. the arm abducted. The tonic spasm lasted 101. An appraisal of the criteria of cerebral death. A 2 Osterman PO, Westerberg CE. Paroxysmal summary statement. A collaborative study. about 60 seconds. About 20 seconds after the neck and on attacks in multiple sclerosis. Brain JAMA 1977;237:982-6. beginning, occipital region 1975;98: 189-202. 8Ruch TC. Brain stem control of posture and the left side became numb, accompanied 3 Shibasaki H, Kuroiwa Y. Painful tonic seizure orientation in space. In: Ruch TC, Patton by simultaneous numbness of the left half in multiple sclerosis. Arch Neurol HD ed, Physiology and Biophysics. The of the tongue. Other parts supplied by 1974;30:47-51. Brain and Neural Function. Philadelphia: trigeminal nerves were not involved. The 4 Bowman JP, Combs CM. The cerebrocortical Saunders, 1979; 14-52. numbness lasted from 30 to 60 seconds. projection of hypoglossal afferents. Exp 9 Twitchell TE. Attitudinal reflexes. Phys Ther Neurol 1969;23:291-301. 1965;45:411-8. The seizure occurred in a stereotyped fash- ion about once an hour. Carbamazepine, Carpenter MB. Human Neuronanatomy 7th ed. Baltimore: Williams & 1976:294. Accepted 10 January 1984 400 mg daily, suppressed the attacks. Wilkins, 6 Brodal A. Neurological Anatomy 3rd. ed. http://jnnp.bmj.com/ This patient developed unilateral numb- Oxford: Oxford University Press, 1981: 513. ness in the neck and tongue during the tonic seizures following the upper cervical Accepted 10 January 1984 Spinal neck-tongue syndrome lesion. The neurologic signs on admission suggested involvement of the left posterior Sir: The neck-tongue syndrome was first funiculus and left corticospinal tract. The HLA antigens and multiple sderosis in described by Lance and Anthony.' Their cause of the myelopathy was not clear. The Greeks patients experienced pain in the neck with exacerbating-remitting course may indicate or without numbness and numbness in the demyelination. Tonic seizures are one of Sir: While the relationship between the tongue on sudden turning of the head. The paroxysmal neurological disturbances in major histocompatibility system (HLA) on October 1, 2021 by guest. authors attributed the symptoms to com- multiple sclerosis and also have been and sucseptibility to multiple sclerosis is pression of the C2 roots in the atlanto-axial reported in traumatic injury of the spinal well documented in northern European space; the numbness of the tongue was cord.2 Although their pathophysiology is populations, there has been controversy caused by compression of proprioceptive unknown, it seems probable that in some over the relationship for ethnic groups of fibres from the tongue through the ansa cases such tonic seizures have a spinal Mediterranean origin. Most workers have hypoglossi, the cervical plexus and finally origin.23 Lance and Anthony' reviewed the noted an increased frequency of HLA-A3 the C2 roots. We wish to report a patient available data on the course of afferent and B7 antigens in multiple sclerosis