A Physical Medicine and Rehabilitation Approach to Bilateral Hypoglossal Palsy After Orotracheal Intubation: A Case Report

Abstract

Isolated hypoglossal nerve palsy is rare, usually unilateral, and typically associated with other neurologic lesions. Very few cases of bilateral hypoglossal nerve palsy have been reported. This report describes the case of a 34-year-old man who was admitted with community-acquired pneumonia and required invasive mechanical ventilation, after which severe tongue paresis, dysarthria, and dysphagia (Functional Oral Intake Scale (FOIS) 3) were reported. After the diagnostic workup, isolated cryptogenic bilateral hypoglossal nerve palsy was assumed, and a rehabilitation program was started. After hospital discharge, the patient presented with tongue atrophy; inability to elevate, protrude, or lateralize the tongue; dysarthria; and increased oral transit time with compensatory cervical extension when swallowing (FOIS 4). Four months after starting the rehabilitation program, there was evidence of improvement in tongue atrophy and mobility, along with a reduction of dysphagia severity (FOIS 6). About 10 months after starting the program, tongue mobility was almost normal, and the patient had a normal diet without limitations (FOIS 7). Despite the rarity of bilateral hypoglossal nerve palsy, this entity is associated with relevant functional impairments. A multidisciplinary approach to diagnosis and tailored rehabilitation programs are highly valuable in the management of these patients.