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Unilateral and Reversible Hypoglossal Nerve Palsy in Infectious Mononucleosis Syndromes: Two Rare Cases from Our
Gheorghiță Jugulete1,2, Mădălina Maria Merișescu1,2, Alexandra Totoianu2
1Faculty of Dentistry, Department of Infectious Diseases, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania.
Abstract:
Background and Clinical Significance: Hypoglossal nerve palsy is an uncommon neurological complication of infectious mononucleosis and is only rarely reported. Putative mechanisms include virus-triggered neuritis (Epstein-Barr virus (EBV) or Cytomegalovirus (CMV)) and/or mechanical compression related to cervical lymphadenopathy. Case Presentation: We report two children with infectious mononucleosis and transient unilateral hypoglossal nerve palsy. Case 1 was a 15-year-old boy with 7 days of fever and typical mononucleosis features who developed leftward tongue deviation accompanied by sialorrhea, dysarthria, and dysphagia. Laboratory testing showed marked hepatocellular injury and EBV-specific IgM positivity. Case 2 was a 9-year-old girl with a 24 h history of bilateral lateral cervical lymphadenopathy with overlying inflammatory signs; examination revealed rightward tongue deviation with similar associated symptoms. CMV-specific IgM antibodies were detected on serological testing. Both patients received systemic corticosteroids and empiric intravenous antibiotics, with supportive care. Hypoglossal nerve function fully recovered within 2-4 weeks of treatment initiation. Conclusions: These cases underscore that isolated hypoglossal nerve palsy may complicate EBV- or CMV-associated mononucleosis in children. Although the prognosis is generally favorable, the presentation warrants careful evaluation to exclude alternative causes of lower cranial neuropathies and close follow-up until complete neurological resolution.
Insights
Infectious mononucleosis can cause rare hypoglossal nerve palsy in children due to Epstein-Barr virus (EBV) or Cytomegalovirus (CMV). Prompt treatment leads to favorable outcomes with full recovery of tongue function.
Area of Science:
- Neurology
- Pediatrics
- Infectious Diseases
Background:
- Hypoglossal nerve palsy is an infrequent neurological complication of infectious mononucleosis.
- Potential causes include virus-induced neuritis (Epstein-Barr virus or Cytomegalovirus) or lymphadenopathy-related compression.
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