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Abstract Details

Isolated Unilateral Hypoglossal Nerve Palsy in a Man with Anterior Cervical Osteophyte
General Neurology
P9 - Poster Session 9 (8:00 AM-9:00 AM)
An Isolated Unilateral Hypoglossal Nerve Palsy (HNP) is a rare occurrence. The etiology of HNP is predominantly due to malignancies producing up to half of the cases, trauma being the second most common etiology. While primary HNP cases usually present with prodromal symptoms, idiopathic unilateral HNP might present without such symptoms. A physical examination could reveal signs such as tongue deviation, fasciculations, atrophy and weakness. We aim to raise awareness of this diagnostically challenging condition.


We report a 65 year old gentleman who presented with right-sided headache and pain in the right half of his tongue for three days. It was associated with speech slurring and difficulty swallowing for one day. The patient is a known case of hypertension on regular medication. Neurological examination was unremarkable except for tongue deviation to the right and dysarthria. On further investigation aided through imaging, magnetic resonance imaging (MRI) of the brain- plain and contrast were performed, which showed anterior bridging thick osteophytes seen at C3 to C5 levels. Computed Tomography (CT) of the neck- plain and contrast study showed the ossification of the posterior longitudinal ligament extending from vertebral levels C1-C3, causing canal stenosis along with contiguous thick anterior bridging osteophytes extending along C3-D1 level, indenting the posterior oropharynx and hypopharynx.


In order to understand the etiology of HNP, it is necessary to take good history. Diagnosis of idiopathic HNP is a diagnosis of exclusion. Practical imaging modalities for diagnosis of HNP due to compressive lesions are MRI and CT. However, in the evaluation of the entire course of hypoglossal nerve to determine the pathology site, MRI is preferred. There are two key objectives in the approach to HNP management- to treat the etiologic cause of palsy and, interventions to restore neurologic function. 

Dhanya Gorty
Miss Gorty has nothing to disclose.
No disclosure on file