Reversible palsy of the hypoglossal nerve complicating infectious mononucleosis in a young child

Hypoglossal Nerve Neuropathies-Analysis of Causes and Anatomical Background

The hypoglossal nerve is the last, and often neglected, cranial nerve. It is mainly responsible for motor innervation of the tongue and therefore the process of chewing and articulation. However, tumors, aneurysms, dissections, trauma, and various iatrogenic factors such as complications after surgeries, radiotherapy, or airway management can result in dysfunction. Correct differential diagnosis and suitable treatment require a thorough knowledge of the anatomical background of the region. This review presents the broad spectrum of hypoglossal neuropathies, paying particular attention to these with a compressive background. As many of these etiologies are not common and can be easily overlooked without prior preparation, it is important to have a comprehensive understanding of the special relations and characteristic traits of these medical conditions, as well as the most common concomitant disorders and morphological traits, influencing the clinical image. Due to the diverse etiology of hypoglossal neuropathies, specialists from many different medical branches might expect to encounter patients presenting such symptoms.

Parálisis idiopática del nervio hipogloso. Descripción de un caso

Introducción: La parálisis del nervio hipogloso es una mononeuropatía poco fre-cuente. Las etiologías más habituales son la tumoral, la traumática, la isquémica cere-bral y la iatrogénica, Descripción: Presentamos el caso de un paciente con neuropa-tía idiopática del nervio hipogloso, en el que por edad, la presencia de factores de riesgo vascular, la microangiopaía cerebral y la evolución nos lleva a discutir acerca de la posibilidad de que se trate de una mononeuropatía isquémica o diabética como etiología del déficit. Discusión: En estudios publicados de parálisis idiopáticas del nervio hipogloso la edad de presentación se sitúa entre los 20 y 45 años y tienen una evolución y recuperación favorable, atribuyéndole un mecanismo fisiopatológico similar al de la paralisis de Bell. En nuestro caso la exploración física y las pruebas complementarias realizadas no mostraron etiología del déficit, encontrándonos ante un nuevo caso de parálisis idiopática del nervio hipogloso. Sin embargo por la edad del paciente, la presencia de múltiples factores de riesgo vascular, la microangiopía cerebral y la persistencia de la sintomatología nos hace plantear la existencia de un mecanismo local, isquémico o diabético, como causa de la mononeuropatía presen-tada y pensar que nos podemos encontrar ante un mecanismo fisiopatológico similar al producido en otras mononeuropatías, como la del III o VI par craneal. Conclusión: Presentamos una parálisis del nervio hipogloso idiopática, que por las característi-cas de nuestro paciente nos hace pensar y discuti una posible etiología isquémica o diabética del déficit.

Isolated unilateral idiopathic transient hypoglossal nerve palsy

A 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.

A case of idiopathic isolated hypoglossal nerve palsy in a Korean child

Hypoglossal nerve palsy (HNP) is an uncommon neurological abnormality that can provoke characteristic clinical signs, including unilateral atrophy of the tongue musculature. We present the case of a healthy 11-year-old Korean male who was admitted to the outpatient department of our institution with acute onset dysarthria, tongue fasciculations, and right-sided tongue weakness upon awakening. His evaluation included a virology work-up, neck magnetic resonance imaging (MRI), brain MRI, and otorhinolaryngological physical examination; all tests were normal and showed no evidence of inflammation. Fifteen days after the onset of symptoms, the patient recovered completely. Herein, we report a case of idiopathic isolated HNP in a Korean male.

Isolated hypoglossal palsy due to cervical osteophyte

INTRODUCTION

Isolated hypoglossal nerve palsy is rare, and etiological diagnosis is difficult. We report a case of isolated hypoglossal compression by a cervical osteophyte in the hypoglossal canal exit.

CASE STUDY

An 86-year-old woman with history of cervical spondylotic myelopathy consulted for a lesion of the free edge of the tongue with impaired elocution. Clinical examination found a bite lesion on the right free edge of the tongue with right lingual amyotrophy and associated left deviation on retraction. Isolated right hypoglossal palsy was diagnosed. Skull base CT found a cervical osteophyte compressing the hypoglossal nerve at the exit from the right hypoglossal canal. Surgery was contra-indicated by the patient's general health status. No motor recovery was observed at 6 months' follow-up, but the elocution disorders regressed under speech therapy.

CONCLUSION

Hypoglossal palsy is infrequent, but generally a sign of skull base pathology. History-taking and careful examination guide rational selection of the radiological examinations required for etiological diagnosis.

[Proximal radial nerve palsy resulting from acute Epstein-Barr virus infection]

Irreparable peripheral nerve palsies rarely present as neurological complications in infectious mononucleosis. A case of isolated proximal radial nerve palsy resulting from an acute infection with Epstein-Barr virus is reported. The hand function was restored by multiple tendon transfer surgery.

Acute disseminated encephalomyelitis following infectious mononucleosis

Two months following an Epstein-Barr virus infection, a 17-year-old white female presented with seizures, intermittent visual changes, and altered mental status. Magnetic resonance imaging showed white matter changes of acute disseminated encephalomyelitis with a predilection for posterior cerebral artery distributions but without radiological evidence of arteritis. Epstein-Barr virus titers and polymerase chain reaction analysis results for the virus were consistent with postinfectious acute disseminated encephalomyelitis. The symptoms and signs improved following treatment with high-dose corticosteroids and intravenous immunoglobulin. Although Epstein-Barr virus can cause acute viral encephalomyelitis, the authors report a case of acute disseminated encephalomyelitis months after acute Epstein-Barr virus infection.