J Neurol Neurosurg Psychiatry doi:10.1136/jnnp-2013-304923
  • Neurological picture

Unilateral isolated hypoglossal nerve palsy associated with internal carotid artery dissection

  1. Leire Agea3
  1. 1Services of Neurology, University Hospital “Marqués de Valdecilla” (IFIMAV), University of Cantabria, Santander, Spain
  2. 2“Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas” (CIBERNED), Santander, Spain
  3. 3Department of Endocrinology, University Hospital “Marqués de Valdecilla” (IFIMAV), University of Cantabria, Santander, Spain
  1. Correspondence to Dr Javier Riancho, Service of Neurology, University Hospital “Marqués de Valdecilla”, Av Valdecilla s/n, Santander 39008, Spain; jariancho{at}
  • Received 11 January 2013
  • Revised 9 February 2013
  • Accepted 11 February 2013
  • Published Online First 7 March 2013

A 54-year-old healthy man was admitted to our hospital with acute dysarthria and mild impairment in swallowing and tongue movements, which he had noticed 2 days before. He was not taking any drugs, and his medical history was unremarkable except for mild hypertension (145/95 mm Hg). He denied prior trauma, fever, facial pain, headache or any other symptoms.

Physical examination showed mild dysarthria and left-sided tongue deviation when the patient poked his tongue out, which was consistent with left hypoglossal nerve palsy (figure 1A). Other cranial nerves were preserved. Carotid murmurs were not heard, and the general and neurological exams were otherwise normal.

Figure 1

(A) Patient's tongue. (B) T2-weighted cranial MRI image and MRI angiography (C) narrowing of …

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