Hypoglossal nerve palsy complicating a case of infectious mononucleosis

Abstract

SummaryA case of infectious mononucleosis complicated by the rare neurological complication of left isolated hypoglossal nerve palsy is described. The literature on cranial nerve palsies in infectious mononucleosis is briefly reviewed.Case report R.G., a 17-year-old management trainee, was admitted to the Radcliffe Infirmary with a 1 week history of sore throat, headache loss of appetite, shivers, nausea and malaise. He had been given a course of penicillin V on the second day of his illness by his general practitioner without improvement.

Unilateral and Reversible Hypoglossal Nerve Palsy Due to Infectious Mononucleosis

“…Four previously reported cases showed recovery within 6 months, two of which were treated using corticosteroids. These cases of CNS involvement of EBV had the same clinical picture as ours [7,8].…”

“…Various neurological diseases, such as encephalitis, meningitis, acute inflammatory polyneuropathy, Bell's palsy, and peripheral neuropathy, may be associated with EBV infection; however, involvement of the central nervous system (CNS) is relatively uncommon [1][2][3][4][5]. Rare cases of hypoglossal nerve palsy associated with acute EBV infection have been reported in children [6][7][8][9]. Herein, we report a case of unilateral and reversible hypoglossal nerve palsy with acute EBV infection.…”

“…In his study, hypoglossal nerve palsy due to infection was infrequently identified, in just 4% (4/100) of patients, and only 15% of cases had a complete or nearly complete recovery. Hypoglossal palsy associated with EBV infection, unlike that caused by many other factors, is characteristically isolated, unilateral, and reversible [6][7][8][9]. If hypoglossal nerve palsy is either bilateral or associated with other cranial nerve signs, neuroimaging is mandatory to exclude other structural causes.…”

Unilateral Isolated Hypoglossal Nerve Palsy Secondary to Tonsillitis

“…In our case, tonsillitis before the onset of HNP was not severe, but the patient had no history of surgery, trauma, or hysteria, and no imaging tests showed stroke and neurological disorders; his HNP was considered to be idiopathic or secondary to tonsillitis. As for paralysis of the hypoglossal nerve due to infection, there are some reports of paralysis associated with infectious mononucleosis caused by the Epstein-Barr virus [4][5][6][7] and neuritis caused by influenza virus [8]. In addition, there have been a few reports of HNP after bacterial tonsillitis; Kovalev and Clarenbach pointed out the possibility of the abnormal running of the hypoglossal nerve in his report [9], while Sakemi et al stated that inflammation of the periphery of the anterior wall of the hypopharynx due to lingual tonsillitis can anatomically cause inflammatory spillover to the hypoglossal nerve [10].…”