Isolated hypoglossal palsy due to cervical osteophyte

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.

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.

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.