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Neurological picture
Isolated hypoglossal nerve palsy caused by synovial cyst
  1. Russell M Hewett,
  2. Gillian E Stewart
  1. Division of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
  1. Correspondence to Russell Hewett, Neurology Specialist Registrar, Ward 31, Division of Clinical Neurosciences, Western General Hospital, Edinburgh EH4 2XU, UK; russellhewett{at}gmail.com

https://doi.org/10.1136/jnnp.2010.227504

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    An 85-year-old lady was referred with a 6-month history of a persistent occipital headache, unrelated to position or movement and with no features of aura or scalp tenderness. She also complained of intermittent speech difficulties, particularly towards the end of the day though she denied dysphagia. Examination was felt to be normal with no evidence of dysarthria in clinic although the patient's dentures were noted to fit poorly. Refitting the dentures did not improve her symptoms.

    CT brain scan and blood results including acetylcholine receptor antibodies were normal. The headaches were rather persistent but finally settled after 6 months after the initiation of amitriptyline. The dysarthria however progressed and at …

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    Footnotes

    • Competing interests None.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.