Isolated unilateral idiopathic transient hypoglossal nerve palsy

Abstract

SUMMARYA 52-year-old Caucasian man presented with sudden onset of difficulty in moving his tongue to the left with preceding left-sided headache with no neck pain. Earlier, he had self-limiting chest infection without rashes or tonsillar enlargement. His medical and surgical history was unremarkable with no recent trauma. Oral examination revealed difficulty in protruding his tongue to the left with muscle bulk loss and fasciculation on the same side, suggesting left hypoglossal nerve palsy. Examination of the rest of the cranial nerves and nervous system was normal. The patient's oropharyngeal and laryngeal examination was unremarkable with no cervical lymphadenopathy. He had normal laboratory investigations and cerebrospinal fluid examination. Extensive imaging of the head, neck and chest failed to reveal any pathology. Further review by an otorhinologist and rheumatologist ruled out any other underlying pathology. He made a good recovery without treatment. English literature search revealed very few cases of idiopathic, transient, unilateral hypoglossal nerve palsy. BACKGROUND

Idiopathic unilateral persistent hypoglossal nerve palsy – literature review and illustrative case

“…Similar to our case, most cases present with symptoms of dysarthria, drooling or dysphagia. Clinical examination is characteristic with tongue deviation to the affected side on protrusion, muscular atrophy and variable fasciculation.…”

Persistent idiopathic unilateral isolated hypoglossal nerve palsy – a report of two cases

“…Idiopathic IUHNP is believed to be an underreported condition which is more frequent than previously thought [6,9]. Ahmed and colleagues found 13 single case reports [3]. Most cases are reversible without any treatment and resolve within 2 to 4 weeks, though longer recovery periods between 2 to 5 months have been reported [1,2,6].…”

“…Most patients complain of dysarthria, while a few patients complain of eating difficulties [1]. In some cases, despite extensive investigations, the cause could not be identified, and therefore, a diagnosis of idiopathic IUHNP was postulated [1][2][3][4][5][6]. Most of these cases are self-limiting, and there are only a few reported cases of persistent idiopathic IUNHP [4,5,7].…”

Persistent Isolated Unilateral Hypoglossal Nerve Palsy

“…The hypoglossal nerve is commonly used in transplant surgery for facial paralysis, suggesting damage to the hypoglossal neve may present in subtle ways [6]. The hypoglossal nerve can be damaged anywhere from the medullary nucleus, hypoglossal canal or skull base [1]. Although the relative benign presentation of hypoglossal nerve palsy and its limited consequences for function, proper assessment and evaluation is necessary to rule out serious underlying causes of this rare pathology.…”

“…Causes of hypoglossal nerve palsy include intracranial space occupying lesions (49%), trauma (12%), stroke (6%), hysteria (6%), surgery (5%), multiple sclerosis (5%), infection (4%), Guillian-Bare syndrome (4%) and idiopathic causes (3%) [1][2][3].…”