Systematic analysis of clinical deficits in unilateral hypoglossal nerve palsy

The clinical characteristics of unilateral hypoglossal neuropathy have not been systematically analyzed.

We documented subjective abnormalities of speech and swallowing, and photographed 9 specific tongue movements and positions. Objective deficits were scored independently by 2 examiners.

Eight patients were analyzed. Some degree of dysarthria and dysphagia was noticed by 7 and 8 patients, respectively, mostly resolving within a few months. In all subjects, there was contralateral deviation of the tongue at rest and ipsilateral deviation upon forward protrusion. Furthermore, 7 of 8 patients had deficits in using the tongue to indent the ipsilateral cheek and cover the upper lip.

Unilateral hypoglossal nerve palsy produces mostly subtle and transient patient symptoms, even when complete. Beyond the classic sign of ipsilateral deviation on protrusion, reliable signs are contralateral deviation at rest, paresis of ipsilateral movement inside the mouth, and paresis of elevation of the tongue tip. Muscle Nerve 54: 1055-1058, 2016.