Abstract
Idiopathic isolated unilateral hypoglossal nerve palsy is a rarely observed finding in clinical practice. Cases of persistent idiopathic isolated hypoglossal nerve palsy are extremely rare, one similar case documenting only one other documented case in the literature. Cases of this finding in patients with epilepsy further make this clinical finding a very rare entity. The presenting case is a 22 year old who complains of deviation of the tongue to the left side upon protrusion and atrophy of the left side of the tongue. The patient was diagnosed with epilepsy at age 10 and had been successfully controlled with medication remaining seizure free for over 10 years.
Highlights
The hypoglossal nerve plays an important role in speech and swallowing
The patient was diagnosed with epilepsy at age 10
Ho et al [2] identified a number of possible causes of hypoglossal nerve palsy including; metastatic disease at the base of the skull, sarcoidosis, autoimmune disease, vasculitis, Arnold Chiari malformation, dural AV fistula of the transverse sinus, periostitis of the hypoglossal canal, postretropharyngeal infection, surgical procedure near neck, acute polymyelitits, syringobulbia, thrombosis of the median branches of the vertebral artery, multiple sclerosis, carotid artery dissection or aneurysm, diabetes mellitus, lacunar infarct over the hypoglossal nucleus, complication of central venous catheterization, head and neck trauma, fracture through the occipital condyle, glomus tumor and meningioma
Summary
The hypoglossal nerve plays an important role in speech and swallowing. Despite the nerves important function, damage to the nerve does not usually present with any functional loss or symptoms that would be overtly noticeable to most patients. 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]. The patient in this case has persistent isolated unilateral left sided hypoglossal nerve palsy and cannot recall when the symptoms first started. Ho et al [2] identified a number of possible causes of hypoglossal nerve palsy including; metastatic disease at the base of the skull, sarcoidosis, autoimmune disease, vasculitis, Arnold Chiari malformation, dural AV fistula of the transverse sinus, periostitis of the hypoglossal canal, postretropharyngeal infection, surgical procedure near neck, acute polymyelitits, syringobulbia, thrombosis of the median branches of the vertebral artery, multiple sclerosis, carotid artery dissection or aneurysm, diabetes mellitus, lacunar infarct over the hypoglossal nucleus, complication of central venous catheterization, head and neck trauma, fracture through the occipital condyle, glomus tumor and meningioma
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