Answers

Abstract

Journal of Paediatrics and Child HealthVolume 50, Issue 11 p. 935-935 Letter to the EditorFree Access Answers First published: 06 November 2014 https://doi.org/10.1111/jpc.12563_2AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Left hypoglossal nerve (cranial nerve XII) palsy Isolated unilateral tongue weakness, in general, implies damage at the level of the hypoglossal nucleus or hypoglossal nerve, rather than a lesion in the cerebral hemisphere. Weakness of the intrinsic tongue muscles allows the contralateral muscles to ‘push’ the tongue towards the side of the lesion. This also applies to the jaw deviation seen with trigeminal (cranial nerve V) nerve palsy, where the weak side is pushed by the contralateral stronger pterygoids, resulting in deviation ipsilateral to the nerve palsy. This is in contrast to the deviation of the angle of mouth seen in facial (cranial nerve VII) and of the uvula seen in vagal (cranial nerve X) nerve palsies, which both deviate contralateral to the side of the pathology. This is well remembered by a mneumonic – Rule of 17 (12 + 5 = 10 + 7). Magnetic resonance imaging brain Hypoglossal nerve palsy is an ominous sign with about 50% patients having an underlying intra- or extra-cranial malignancy.1 It has also been described with varied aetiologies including gunshot wound to the neck, blunt head trauma, stroke, multiple sclerosis, internal carotid artery aneurysm, and post-infectious and post-vaccination neuropathy.2 Surgical trauma due to branchial cyst removal Magnetic resonance imaging of the brain was done and was unremarkable. Hypoglossal nerve palsy resulting from infected neck cysts or its surgical removal has been reported.3, 4 Malformations arising from the second or third branchial cleft remnants are in anatomic proximity to the hypoglossal nerve, making it prone to surgical trauma. The chances of recovery in these cases are low, although patients may continue to be ‘asymptomatic’ as was our patient. References 1Keane JR. Twelfth-nerve palsy. Analysis of 100 cases. Arch. Neurol. 1996; 53: 561– 566. CrossrefCASPubMedWeb of Science®Google Scholar 2Combarros O, Alvarez de Arcaya A, Berciano J. Isolated unilateral hypoglossal nerve palsy: nine cases. J. Neurol. 1998; 245: 98– 100. CrossrefCASPubMedWeb of Science®Google Scholar 3Gatot A, Tovi F, Fliss DM, Yanai-Inbar I. Branchial cleft cyst manifesting as hypoglossal nerve palsy. Head Neck 1991; 13: 249– 250. Wiley Online LibraryCASPubMedWeb of Science®Google Scholar 4Mukherjee SK, Gowshami CB, Salam A, Kuddus R, Farazi MA, Baksh J. A case with unilateral hypoglossal nerve injury in branchial cyst surgery. J. Brachial Plex. Peripher. Nerve Inj. 2012; 7: 2. CrossrefPubMedGoogle Scholar Volume50, Issue11November 2014Pages 935-935 ReferencesRelatedInformation