“Tongue Tied” Man with Opiate Addiction

Abstract

44-year-old man with history of opiate addiction (last 12 month on methadone 40–70 mg/daily) and alcohol problems in the past (admitting up to 15 units a day) was admitted via A&E. At A&E he complained about speech difficulties and right sided headache. He reported his symptoms lasting for last 2 weeks. During that period he drank alcohol extensively. He could not rule out neck or head injury as there was significant amnesia linked to alcohol. For the same reason he also could not rule out any loss of consciousness during that period. He was not certain about use of other illicit drugs (e.g. cocaine, heroin, amphetamine). On admission there was obvious dysarthria/slurred speech and dysphagia. There were no obvious traumatic changes on his neck or head. On objective examination bilateral complete hypoglossal nerve palsy was found. Other cranial nerves were normal. There were no other signs of motor or sensory deficit. Pupils were symmetrical and responsive with no signs of Horner’s syndrome. Masseter jerk was absent. Patient was significantly hypertensive on admission (systolic pressure 143–192, diastolic 103–128.). Speech and language team reviewed patient and swallowing was assessed. Nasogastric tube was not needed.