Lingual Artery Infarct

The initial complaint of a 79-year-old woman was of mild headache, neck pain, and sore throat. She had a history of hypertension, diabetes mellitus, and heavy cigarette smoking. Examination by an otolaryngologist, which included laryngoscopy, revealed no abnormalities. Three weeks later, the patient's throat and neck pain became more severe. She had no arthralgias, visual loss, fever, or worsening head pain.

The only notable result of laboratory studies was an erythrocyte sedimentation rate of 77 mm/h. The suspected diagnosis of temporal arteritis was confirmed by a temporal artery biopsy. Oral prednisone therapy was instituted immediately.

Four days later, the patient complained of severe tongue pain; the affected area was tender and cyanotic. She had an infarcted branch of the left lingual artery, and her tongue eventually appeared as seen here. She was given IV corticosteroids and fluids until the pain resolved and then returned to oral prednisone therapy. This woman's corticosteroid course was complicated by accelerated hypertension and diabetes, and by edema. She is currently receiving a very low dose of corticosteroids and is doing well clinically.

Writes Dr Rebecca Galante of Hammond, Ind, cranial arteritis is a common finding among elderly patients with headache and visual loss. Approximately 25% of these patients have complaints limited to the oral cavity-most often, jaw claudication and tongue pain. Frank tongue infarction is rare.