A 33-year-old woman presented with five days of dysarthria and dysphagia. Her past medical history included Graves’ disease treated with a partial thyroidectomy five years earlier. On examination, she had tongue mounding and deviation to the right (Figs. 1 and 2). Other neurological and otorhinolaryngological findings were normal. Titers of herpes simplex virus and varicella-zoster virus antibodies were positive, but did not differ between the acute and convalescent phase sera. Brain magnetic resonance imaging (MRI) and magnetic resonance angiogram (MRA) findings were normal, and laboratory tests showed no evidence of inflammation. Idiopathic isolated unilateral hypoglossal nerve palsy was diagnosed.
While cranial nerves III, IV, VI and VII are more prone to idiopathic palsy, idiopathic unilateral hypoglossal nerve palsy is rare. With the limited number of cases reported, the male-to-female ratio appears even, the age of onset is widely distributed (20–69 years) and the majority of cases self-resolve.1 In acute isolated hypoglossal nerve palsy, malignancy, vascular pathology, herpes infection, systemic lupus erythematosus, multiple sclerosis and diabetic mononeuropathy have been reported as causes.1–3 Although the paired sera failed to show acute herpes infection in this case, reactivation of the disease could still be possible. Eight weeks after symptom onset, this patient fully recovered without intervention.
Combarros O, AlvarezdeArcaya A, Berciano J. Isolated unilateral hypoglossal nerve palsy: nine cases. J Neurol. 1998;245:98–100.
Freedman M, Jayasundara H, Stassen LF. Idiopathic isolated unilateral hypoglossal nerve palsy: a diagnosis of exclusion. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;106:22–6.
Chan CH, Li E, Lai FM, Pang JA. An unusual case of systemic lupus erythematosus with isolated hypoglossal nerve palsy, fulminant acute pneumonitis, and pulmonary amyloidosis. Ann Rheum Dis. 1989;48:236–9.
This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.
About this article
Cite this article
Shikino, K., Noda, K. & Ikusaka, M. Transient Idiopathic Isolated Unilateral Hypoglossal Nerve Palsy. J GEN INTERN MED 28, 591 (2013). https://doi.org/10.1007/s11606-012-2228-9
- hypoglossal nerve palsy