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Isolated acute bilateral hypoglossal nerve (CXII) paralysis is a very rare clinical condition which has been described in the context of traumatic mechanical injuries to the nerves.1 The two nuclei of CXII, located at the tegmentum of the medulla oblongata, are in close proximity and may be damaged at the same time.2 However, isolated bilateral CXII paralysis has not been described in cases of medullary infarction. We report a patient presenting with isolated complete tongue paralysis and a small ischaemic area in the medulla affecting both CXII nuclei exclusively.
A 49 year old woman with a history of primary biliary cirrhosis presented to the emergency room with acute dysarthria, swallowing difficulty, and inability to protrude her tongue. She was unable to eat, drink, or handle saliva. She denied vertigo, dizziness, nausea, unsteady gait, numbness, or weakness.
Examination showed that she was alert and responsive but was dysarthric and unable to initiate a swallow. Pupils were 3 mm in diameter, equal, and reactive to light and accommodation Extraocular movements were full. There was no ptosis and the corneal reflex was present bilaterally. Sensation was intact to light touch and pin prick. There was no spontaneous or gaze nystagmus, saccadic pursuit, or ocular dysmetria. Facial …