Anatomically, the hypoglossal nerve would not be at risk during this procedure. The hypoglossal nerve stimulator inspire medical systems is an implantable device that, using a sensing electrode placed between the intercostal muscles and stimulation lead placed around anterior branches of the hypoglossal nerve, delivers electrical impulses to tongue protrusor muscles at the time of inspiration, alleviating upper airway. Isolated hypoglossal nerve palsy due to mechanical compression by a vascular lesion is rare. Jeanpierre barral, alain croibier, in manual therapy for the cranial nerves, 2009. This article is from journal of surgical case reports, volume 2014. Hypoglossal nerve palsy is a rare occurrence usually associated with other cranial nerve palsies and long tract signs.
Hypoglossal nerve palsy as a complication of transoral. Hypoglossal nerve palsy hnp is a potential cause of dysphagia. The most common cranial nerve palsy is a hypoglossal nerve injury, which accounts for more than half of all cranial neuropathies after cea, according to one recent study. Pdf unilateral palsy of the hypoglossal nerve is a rare complication of. Case of idiopathic isolated unilateral hypoglossal nerve. Gibo h, marinkovic s, nikodijevic i, stimec b, erden a. Hypoglossal nerve injury an overview sciencedirect topics. Although we could not establish the cause of our patients disease, an awareness of this condition could relieve such patients from unnecessary invasive studies. Previous studies suggested that an enlarged canalicular venous plexus may.
Hypoglossalnerve palsy caused by carotid dissection. This is found the full length of the medulla, close to the midline. The hypoglossal nerve is the motor supply to the tongue muscles and may be damaged in its intracranial or extracranial course. Transient, unilateral, isolated hypoglossal nerve palsy. Robaina bordon and others published isolated hypoglossal nerve palsy find, read and cite all the research you need on researchgate. The roots of the hypoglossal nerve itself arise between the olive and the pyramid. Patients with hnp present with a wide range of symptoms, including. Persistent idiopathic unilateral isolated hypoglossal nerve.
Archives of clinical and medical case reports 2 2018. Isolated bilateral paralysis of the hypoglossal nerve. To improve understanding of this entity, we present a retrospective series of 18 patients with hypoglossal palsy in whom twelfth cranial nerve compression within the premedullary cistern or hypoglossal canal, or both, was found. Carotid artery dissection causing an isolated hypoglossal. Vascular, inflammatory, traumatic, or spaceoccupying lesions can affect the cn xii anywhere in its course, from the nucleus in the caudal medulla, through the intracranial extramedullary portion of the nerve, across the hypoglossal canal, or into its extracranial termination. We report the case of a 72yearold man who presented with a 4year history of swallowing disturbance and subsequently progressively worsening leftsided tongue atrophy. Cisternal hypoglossal schwannoma with tongue atrophy 42. Bells palsy and partial hypoglossal to facial nerve transfer. To my knowledge, iih is not mra of the neck vessels showed no dissection orassociated with hypoglossal palsy. A 66yearold man presented to our hospital with dysphagia and neck pain. Hypoglossal nerve palsy hnp is an uncommon cranial nerve palsy comparing to other commoner cranial nerves such as 3rd, 6th, and 7th cranial nerves 4. Isolated hypoglossal nerve palsy hnp presents with ipsilateral tongue deviation due to atrophy of the tongue musculature. Previous studies suggested that an enlarged canalicular venous plexus may be responsible for the hypoglossal nerve palsy 5, 6. The electromyographic emg examination showed a clear decrease of the amplitude and a single nerve fiber activity without any degenerative potentials, indicating a transient nerve lesion.
Hypoglossal nerve definition of hypoglossal nerve by the. Hypoglossal nerve palsy as a cause of severe dysphagia along. Disorders of the 12th cranial nerve hypoglossal nerve cause weakness or wasting atrophy of the tongue on the affected side. Apart from a case series of 100 subjects in 1996 and several small cohorts, there have been no large retrospective series of cranial nerve xii cn xii palsy.
The clinical examination is the principal method by which hypoglossal nerve palsy can be detected, but imaging studies, either computed tomography or magnetic. Hypoglossal nerve palsy hypoglossal nerve disorder. Abstractwe report a case of isolated unilateral hypoglossal nerve injury following. A woman in her 50s presented to the emergency room with complaints of gait instability. The hypoglossal nerve is the twelfth and last cranial nerve and supplies the tongue with motor control. Isolated hypoglossal nerve palsy is uncommon because of its intimate relationship with the other lower cranial nerves. Hypoglossal nerve stimulation in adolescents with down. Pdf the hypoglossal nerve receives only brief mention in most textbooks and compared with other cranial nerve palsies, 12th nerve palsy is much less. Between 2014 and 2015, we examined 6 patients with hypoglossal nerve palsy and a prior operation of the hypoglossal nerve and a patient with neurofibromatosis, who were referred to our department. Hypoglossalvertebral entrapment syndrome neurology.
Isolated hypoglossal nerve palsy in a child article pdf available in the turkish journal of pediatrics 461. Isolated unilateral hypoglossal nerve palsy due to vertebral. Carotid artery dissection causing an isolated hypoglossal nerve palsy. Intracranial plasmacytoma with hypoglossal nerve palsy in. Cranialnerve palsies are seen in 12% of patients with carotid artery dissection. The hypoglossal nerve is the twelfth cranial nerve, and innervates all the extrinsic and intrinsic muscles of the tongue, except for the palatoglossus which is innervated by the vagus nerve.
Likewise, park et al 6 reported 2 cases of hypoglossal nerve palsies, which were also suggested to be related to excessive neck flexion. Isolated unilateral hypoglossal nerve palsy british. Hypoglossal nerve article about hypoglossal nerve by the. These roots then unite to form two bundles which then pass through the hypoglossal canal in the occipital bone by piercing the dura mater. Imaging features of isolated hypoglossal nerve palsy sciencedirect. The hypoglossal nerve also provides lingual pressure to drive the bolus through the pesues. The hypoglossal canal contains the canalicular segment of the 12th cranial nerve, a branch of the ascending pharyngeal artery, and the anterior condylar venous plexus. The nerve arises from the hypoglossal nucleus in the brain stem as a number of small rootlets, passes through. Nov 17, 2015 this video is part of a playlist of short videos which are intended to combine multiple choice questions answering experience with an improved understanding of anatomy. Cranial nerve palsy in ica dissection occurs in 312% of all patients, mostly involving the lower cranial nerves ix to xii.
Hypoglossal nerve palsy is an uncommon neurological deficit characterized by unilateral weakness andor atrophy of the tongue that may arise due to trauma, iatrogenic causes eg. The underlying pathology of its occurrence is very diverse. Unilateral lesions usually suggest spaceoccupying lesions while bilateral involvement is usually due to nerve degeneration or demyelination. Damage to this nerve produces characteristic clinical manifestations, of which unilateral atrophy of the tongue musculature is the most important. Isolated hypoglossal nerve palsy neurologia english edition. Sir, hypoglossal nerve palsy hnp is a rare condition affecting the head and neck region.
Isolated peripheral hypoglossal palsy caused by a kinking of the left vertebral artery hypoglossal vertebral entrapment syndrome. The hypoglossal nerve arises from the hypoglossal nucleus. Her examination was notable for tongue deviation to the left. Bilateral hypoglossal nerve palsy due to brainstem infarction. Young patient with isolated tongue deviation stroke. One year prior to his first visit, he had been diagnosed with upper cervical tuberculosis and had undergone posterior c12 fixation. Hypoglossal nerve disorders may be caused by tumors, strokes, infections, injuries, or amyotrophic lateral sclerosis. We describe a case of isolated idiopathic hypoglossal nerve palsy in a young male patient and discuss several of the aetiopathogenic mechanisms which may. Scullys medical problems in dentistry seventh edition, 2014. When a disorder of hypoglossal nerve exists, the corresponding half of the tongue becomes paralyzed, and the tongue muscles atrophy. Hypoglossal nerve palsy medigoo health medical tests. Hypoglossal nerve disorders merck manuals consumer version. Hypoglossal nerve palsy is a common finding in neurological diseases when associated with other cranial nerve palsy or further pathology.
Hypoglossal nerve palsy exits the medulla oblongata, extends through the skull base, and traverses the suprahyoid neck before ramifying to supply the tongue musculature. The nerve arises from the hypoglossal nucleus in the medulla as a number of small rootlets, passes through the. Jul 27, 2018 sir, hypoglossal nerve palsy hnp is a rare condition affecting the head and neck region. Mateen, et al, stenosis of the extracranial circulation. According to the copenhagen facial nerve study, spontaneous facial nerve palsy bells palsy is a benign condition which implies an acute unilateral partial or total facial motor deficit of undetermined etiology, having an incidence of 32100,000, without seasonal, side, or gender variations, and is more frequent between 15 and 60 years. Tongue pseudohypertrophy in idiopathic hypoglossal nerve. Is hypoglossal nerve palsy caused by craniocervical junction.
The transient isolated hypoglossal nerve palsy could have been due to the infected impacted tooth. Isolated hypoglossal nerve palsy is a very rare condition. The physical examination led to the diagnosis of dysphagia with hnp, and he had severe weight loss. Isolated hypoglossal palsy caused by synovial cyst 43.
Pdf hypoglossal nerve paralysis in a child after a dental procedure. Hypoglossal nerve palsy after airway management for. Twelfth nerve palsies have frequently been reported in association with the following conditions. Hypoglossal nerve cranial nerve xii palsy is uncommon.
The hypoglossal nerve cn xii is the motor nerve of the tongue. Unilateral isolated hypoglossal nerve palsy due to. Also known as hypoglossalfacial anastomosis, the hypoglossal nerve transfer is performed less frequently these days as more awareness now exists about other options. There are a few reports in the literature of isolated unilateral hypoglossal nerve palsy with a benign course, secondary to an infections process 35 or vaccination 7. The next day, clinical examination revealed a hypoglossal nerve palsy on the left. Hypoglossal nerve palsy after airway management for general. Other reasons for hypoglossal nerve dysfunction were multiple sclerosis 6%, surgery 5%, guillainbarre neuropathy 4%, and infection 4%. These patients 4 men and 2 women with a mean age of 54. Isolated bilateral paralysis of the hypoglossal nerve after. Clinically, hypoglossal nerve palsy manifests with difficulty chewing, swallowing and with dysarthric. A rare presentation of presumed pyogenic meningitis. Isolated hypoglossal nerve palsy hnp, or neurapraxia, a rare postoperative complication after airway management, causes ipsilateral tongue deviation, dysarthria, and dysphagia.
Spontaneous internal carotid artery dissection icad is now recognized as an important cause of ischemic stroke in patients younger than 45 years of age, with. In the current series, the one reported hypoglossal nerve palsy was transient and occurred following a c37 posterior fusion. A rare combination of facial and hypoglossal nerve palsies. The fibers of the hypoglossal nerve arise in the hypoglossal nuclei, which extend through the medulla oblongata in a paramedian location. Hypoglossal nerve palsy after cervical spine surgery. Imaging demonstrated basilar invagination and compression of the preolivary sulci near the cranial nerve 12 nerve root exit zone figures 1 and 2.
Isolated hypoglossal nerve palsy from internal carotid artery. The hypoglossal nerve gives motor innervation to the intrinsic and extrinsic muscles of the tongue. Isolated hypoglossal nerve palsy is uncommon, and underlying craniocervical junction degenerative disease has rarely been reported as an underlying cause. Different common causes were trauma, medullary infarctions, multiple sclerosis, guillain. Hypoglossal nerve definition of hypoglossal nerve by. Physiotherapy management of peripheral unilateral isolated. Keane analysed 100 cases of hypoglossal nerve palsy and found that most of them were caused by tumours. Vertebrobasilar dolichoectasia with hypoglossal nerve palsy 40. Isolated partial, transient hypoglossal nerve injury. Disruption of the hypoglossal nerve track, such as within lingual muscles case report 1, or through encroachment of the hypoglossal foramina, case report 2, will yield lmn pattern weakness, similar to that of bals. Isolated hypoglossal nerve palsy due to infected impacted tooth.
Imaging studies including brain andseventh nerve palsy and exceptionally, with cervical mri, mra of the head and mrv were normal. The hypoglossal nerve receives only brief mention in most textbooks and compared with other cranial nerve palsies, 12th nerve palsy is much less common. Therefore, the dentist or doctors coming across with isolated hypoglossal nerve palsy should consider the infected impacted tooth as the differential diagnosis. Isolated hypoglossal nerve palsy ihnp although a rare condition, has been previously reported. Hypoglossal nerve an overview sciencedirect topics. Cranial nerve palsies are seen in 12% of patients with carotid artery dissection. A deviation of the protruded tongue to the left side indicates leftsided dysfunction of the hypoglossal nerve because the contralateral genioglossal muscle pushes the tongue forward and, in the case of contralateral palsy, toward the affected side. After leaving the skull, the hypoglossal nerve forms an arch and, at the anterior end of the hyoglossal muscle, branches into terminal branches, which innervate the musculature of the tongue. To improve understanding of this entity, we present a retrospective series of 18 patients with hypoglossal palsy in whom twelfth cranial nerve compression within the premedullary cistern or hypoglossal canal, or both. Basilar invagination is a rare craniocervical malformation, which can cause neurologic deficits. This video is part of a playlist of short videos which are intended to combine multiple choice questions answering experience with an improved understanding of anatomy. If that tongue isnt wagging quite the way it should be, potential treatment strategies may include.
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