Unilateral Atrophy of the Tongue: Hypoglossal Palsy Due to Neurovascular Contact?

Background: Hypoglossal nerve palsy in children is rare and has a wide spectrum of etiologies. In adults, most frequently it occurs as a complication of carotid endarterectomy or after radiation, furthermore schwannomas are a common cause. Neurovascular contact in the course of hypoglossal palsy is extremely rare but a possible cause for 12th nerve palsy.

Case Report: We report on a 15.5-year-old boy presenting with unilateral hypoglossal palsy. Three months prior to consultation, he noticed a tongue deviation to the ride side for the first time which had been preceded by an increased frequency of biting his own tongue. Articulation became unclear, the tongue felt clumsy and tight. In addition to these symptoms an atrophy and fasciculations of the right tongue were identified on physical examination. There was no evidence of CNS inflammation, traumatic lesions by former operations in the pertaining region or a history of difficult intubation. The cranial MRI revealed a neurovascular contact of the right hypoglossal nerve and an aberrant occipital artery (branch of ICA) in the high-resolution T1-SPIR (Spectral Presaturation with Inversion Recovery) sequence. At the sight of neurovascular contact tissue thickening and contrast enhancement could be observed. Thus, diagnosis of a schwannoma has to be taken into consideration.

Conclusion: Assuming a neurovascular contact, well-known in trigeminal neuralgia, a microvascular decompression can be performed. In our case the benefit of this surgical procedure might be limited due to the pronounced atrophy of the tongue.

No conflict of interest has been declared by the author(s).