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Updated: Jun 20, 2026

A Protocol for Comprehensive Assessment of Bulbar Dysfunction in Amyotrophic Lateral Sclerosis (ALS)
Published on: February 21, 2011
[Unilateral tongue atrophy and articulation difficulties]
J-C Lüers1, P Isfort, H Bovenschulte
1Klinik und Poliklinik für Hals-, Nasen-, Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Uniklinik Köln, Kerpener Strasse 62, 50924, Köln, Deutschland. jan-christoffer.lueers@uk-koeln.de
Abstract:
A 24-year-old female complained of difficulty articulating and chewing of 2 more than weeks' standing. She reported that her tongue felt "heavy and inert". Clinically, right-sided atrophy of the tongue and deflection of the tongue to the right were observed. Tone audiogram demonstrated normal hearing on both sides and tympanometry was also normal. On CT, a bone-destroying process was seen in the area of the right lateral skull base, which reached as far as the internal carotid artery. MRI demonstrated atrophy of the right tongue musculature with fatty degeneration, as well as an oval, smoothly edged lesion which showed marked contrast-medium uptake with a "salt and pepper" configuration in the region of the right jugular foramen. The diagnosis was hypoglossal paresis due to ipsilateral jugular paraganglioma (Fisch classification C1). Following embolization of the feeding vessels of the paraganglioma, the tumor was completely resected, including the hypoglossal nerve which ran through the tumor. Postoperative dysfunction of the vagus and facial nerves became unsymptomatic with time as a result of logopedic therapy.
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