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Hypoglossal Nerve Motor Denervation
Richard H. Wiggins, III, MD, CIIP, FSIIM
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Diagnostic Checklist

            TERMINOLOGY

            • Synonyms

              • Hypoglossal nerve (CNXII) palsy, hypoglossal nerve paralysis, tongue denervation
            • Definitions

              • Loss of nerve supply to muscles in 1/2 of tongue
                • Note palatoglossus supplied by CNX

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Nuclear Medicine Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      • Image Interpretation Pearls

                                        • Reporting Tips

                                          Selected References

                                          1. Nestola DF et al: Isolated hypoglossal nerve palsy mimicking a base of tongue tumor. J Craniofac Surg. 28(1):e78-e80, 2017
                                          2. Stino AM et al: Hypoglossal nerve palsy: 245 cases. Muscle Nerve. 54(6):1050-1054, 2016
                                          3. Weindling SM et al: Is Hypoglossal Nerve Palsy Caused by Craniocervical Junction Degenerative Disease an Underrecognized Entity? AJNR Am J Neuroradiol. ePub, 2016
                                          4. Ryan P et al: Acute tongue swelling, the only initial manifestation of carotid artery dissection: a case report with differentiation of clinical picture. Ann Vasc Surg. 29(2):365.e17-8, 2015
                                          5. Bensoussan Y et al: Atypical presentation of Eagle syndrome with hypoglossal nerve palsy and Horner syndrome. Head Neck. 36(12):E136-8, 2014
                                          6. Patro SN et al: An unusual case of isolated hypoglossal nerve palsy secondary to osteophytic projection from the atlanto-occipital joint. Neuroradiol J. 27(3):361-4, 2014
                                          7. De Santis F et al: Internal carotid artery dissection after inferior alveolar nerve block for third molar dental care presented as hypoglossal nerve palsy. Vasc Endovascular Surg. 46(7):591-5, 2012
                                          8. Junquera L et al: Images in clinical medicine. Denervation atrophy of the tongue after hypoglossal-nerve injury. N Engl J Med. 367(2):156, 2012
                                          9. Learned KO et al: Hypoglossal nerve palsy missed and misinterpreted: the hidden skull base. J Comput Assist Tomogr. 36(6):718-24, 2012
                                          10. Alves P: Imaging the hypoglossal nerve. Eur J Radiol. 74(2):368-77, 2010
                                          11. Mendes-Araujo L et al: Case report. Atlantoaxial synovial cyst causing isolated unilateral hypoglossal nerve paralysis. Br J Radiol. 83(986):e35-8, 2010
                                          12. Holle D et al: Neurological picture. Tongue pseudohypertrophy in idiopathic hypoglossal nerve palsy. J Neurol Neurosurg Psychiatry. 80(12):1393, 2009
                                          13. Hui AC et al: Hypoglossal nerve palsy. Hong Kong Med J. 15(3):234, 2009
                                          14. Lin HC et al: Cranial nerve XII: the hypoglossal nerve. Semin Neurol. 29(1):45-52, 2009
                                          15. Lopes G et al: Two cases of isolated unilateral paralysis of hypoglossal nerve after uncomplicated orotracheal intubation. Acta Anaesthesiol Belg. 60(3):191-3, 2009
                                          16. Marin LF et al: Hypoglossal nerve palsy as the sole manifestation of spontaneous internal carotid artery dissection. Arq Neuropsiquiatr. 67(1):107-8, 2009
                                          17. Zeina AR et al: Hypoglossal nerve palsy secondary to cervical spine involvement in rheumatoid arthritis: clinical and radiological features. Joint Bone Spine. 76(5):547-9, 2009
                                          18. Billan S et al: Radiation-induced hypoglossal nerve palsy. Isr Med Assoc J. 9(2):134, 2007
                                          19. Graham RM et al: Isolated hypoglossal nerve palsy due to a vascular anomaly. Int J Oral Maxillofac Surg. 36(8):759-61, 2007
                                          20. Khoo SG et al: Isolated hypoglossal nerve palsy: a harbinger of malignancy. J Laryngol Otol. 121(8):803-5, 2007
                                          21. Chugh S et al: Occipital condyle fracture with associated hypoglossal nerve injury. Can J Neurol Sci. 33(3):322-4, 2006
                                          22. Hong JT et al: Hypoglossal nerve palsy after posterior screw placement on the C-1 lateral mass. Case report. J Neurosurg Spine. 5(1):83-5, 2006
                                          23. Chien JT et al: Atlantoaxial rotatory dislocation with hypoglossal nerve palsy in a patient with ankylosing spondylitis. A case report. J Bone Joint Surg Am. 87(7):1587-90, 2005
                                          24. Zafeiriou DI et al: Images in clinical medicine. Hypoglossal-nerve palsy. N Engl J Med. 350(5):e4, 2004
                                          25. Lindsay FW et al: Subacute hypoglossal nerve paresis with internal carotid artery dissection. Laryngoscope. 113(9):1530-3, 2003
                                          26. Kaushik V et al: Isolated unilateral hypoglossal nerve palsy after minor head trauma. Clin Neurol Neurosurg. 105(1):42-7, 2002
                                          27. Loh C et al: Cranial nerve XII: the hypoglossal nerve. Semin Ultrasound CT MR. 23(3):256-65, 2002
                                          28. Pavithran K et al: Isolated hypoglossal nerve palsy due to skull base metastasis from breast cancer. Australas Radiol. 45(4):534-5, 2001
                                          29. King AD et al: MR features of the denervated tongue in radiation induced neuropathy. Br J Radiol. 72(856):349-53, 1999
                                          30. Murakami R et al: MR of denervated tongue: temporal changes after radical neck dissection. AJNR Am J Neuroradiol. 19(3):515-8, 1998
                                          31. Murakami R et al: CT and MR findings of denervated tongue after radical neck dissection. AJNR Am J Neuroradiol. 18(4):747-50, 1997
                                          32. Russo CP et al: MR appearance of trigeminal and hypoglossal motor denervation. AJNR Am J Neuroradiol. 18(7):1375-83, 1997
                                          33. Harnsberger HR et al: Major motor atrophic patterns in the face and neck: CT evaluation. Radiology. 155(3):665-70, 1985
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Pathology

                                                  • Diagnostic Checklist

                                                    TERMINOLOGY

                                                    • Synonyms

                                                      • Hypoglossal nerve (CNXII) palsy, hypoglossal nerve paralysis, tongue denervation
                                                    • Definitions

                                                      • Loss of nerve supply to muscles in 1/2 of tongue
                                                        • Note palatoglossus supplied by CNX

                                                    IMAGING

                                                    • General Features

                                                      • CT Findings

                                                        • MR Findings

                                                          • Nuclear Medicine Findings

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  • Staging, Grading, & Classification

                                                                    • Microscopic Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Natural History & Prognosis

                                                                          • Treatment

                                                                            DIAGNOSTIC CHECKLIST

                                                                            • Consider

                                                                              • Image Interpretation Pearls

                                                                                • Reporting Tips

                                                                                  Selected References

                                                                                  1. Nestola DF et al: Isolated hypoglossal nerve palsy mimicking a base of tongue tumor. J Craniofac Surg. 28(1):e78-e80, 2017
                                                                                  2. Stino AM et al: Hypoglossal nerve palsy: 245 cases. Muscle Nerve. 54(6):1050-1054, 2016
                                                                                  3. Weindling SM et al: Is Hypoglossal Nerve Palsy Caused by Craniocervical Junction Degenerative Disease an Underrecognized Entity? AJNR Am J Neuroradiol. ePub, 2016
                                                                                  4. Ryan P et al: Acute tongue swelling, the only initial manifestation of carotid artery dissection: a case report with differentiation of clinical picture. Ann Vasc Surg. 29(2):365.e17-8, 2015
                                                                                  5. Bensoussan Y et al: Atypical presentation of Eagle syndrome with hypoglossal nerve palsy and Horner syndrome. Head Neck. 36(12):E136-8, 2014
                                                                                  6. Patro SN et al: An unusual case of isolated hypoglossal nerve palsy secondary to osteophytic projection from the atlanto-occipital joint. Neuroradiol J. 27(3):361-4, 2014
                                                                                  7. De Santis F et al: Internal carotid artery dissection after inferior alveolar nerve block for third molar dental care presented as hypoglossal nerve palsy. Vasc Endovascular Surg. 46(7):591-5, 2012
                                                                                  8. Junquera L et al: Images in clinical medicine. Denervation atrophy of the tongue after hypoglossal-nerve injury. N Engl J Med. 367(2):156, 2012
                                                                                  9. Learned KO et al: Hypoglossal nerve palsy missed and misinterpreted: the hidden skull base. J Comput Assist Tomogr. 36(6):718-24, 2012
                                                                                  10. Alves P: Imaging the hypoglossal nerve. Eur J Radiol. 74(2):368-77, 2010
                                                                                  11. Mendes-Araujo L et al: Case report. Atlantoaxial synovial cyst causing isolated unilateral hypoglossal nerve paralysis. Br J Radiol. 83(986):e35-8, 2010
                                                                                  12. Holle D et al: Neurological picture. Tongue pseudohypertrophy in idiopathic hypoglossal nerve palsy. J Neurol Neurosurg Psychiatry. 80(12):1393, 2009
                                                                                  13. Hui AC et al: Hypoglossal nerve palsy. Hong Kong Med J. 15(3):234, 2009
                                                                                  14. Lin HC et al: Cranial nerve XII: the hypoglossal nerve. Semin Neurol. 29(1):45-52, 2009
                                                                                  15. Lopes G et al: Two cases of isolated unilateral paralysis of hypoglossal nerve after uncomplicated orotracheal intubation. Acta Anaesthesiol Belg. 60(3):191-3, 2009
                                                                                  16. Marin LF et al: Hypoglossal nerve palsy as the sole manifestation of spontaneous internal carotid artery dissection. Arq Neuropsiquiatr. 67(1):107-8, 2009
                                                                                  17. Zeina AR et al: Hypoglossal nerve palsy secondary to cervical spine involvement in rheumatoid arthritis: clinical and radiological features. Joint Bone Spine. 76(5):547-9, 2009
                                                                                  18. Billan S et al: Radiation-induced hypoglossal nerve palsy. Isr Med Assoc J. 9(2):134, 2007
                                                                                  19. Graham RM et al: Isolated hypoglossal nerve palsy due to a vascular anomaly. Int J Oral Maxillofac Surg. 36(8):759-61, 2007
                                                                                  20. Khoo SG et al: Isolated hypoglossal nerve palsy: a harbinger of malignancy. J Laryngol Otol. 121(8):803-5, 2007
                                                                                  21. Chugh S et al: Occipital condyle fracture with associated hypoglossal nerve injury. Can J Neurol Sci. 33(3):322-4, 2006
                                                                                  22. Hong JT et al: Hypoglossal nerve palsy after posterior screw placement on the C-1 lateral mass. Case report. J Neurosurg Spine. 5(1):83-5, 2006
                                                                                  23. Chien JT et al: Atlantoaxial rotatory dislocation with hypoglossal nerve palsy in a patient with ankylosing spondylitis. A case report. J Bone Joint Surg Am. 87(7):1587-90, 2005
                                                                                  24. Zafeiriou DI et al: Images in clinical medicine. Hypoglossal-nerve palsy. N Engl J Med. 350(5):e4, 2004
                                                                                  25. Lindsay FW et al: Subacute hypoglossal nerve paresis with internal carotid artery dissection. Laryngoscope. 113(9):1530-3, 2003
                                                                                  26. Kaushik V et al: Isolated unilateral hypoglossal nerve palsy after minor head trauma. Clin Neurol Neurosurg. 105(1):42-7, 2002
                                                                                  27. Loh C et al: Cranial nerve XII: the hypoglossal nerve. Semin Ultrasound CT MR. 23(3):256-65, 2002
                                                                                  28. Pavithran K et al: Isolated hypoglossal nerve palsy due to skull base metastasis from breast cancer. Australas Radiol. 45(4):534-5, 2001
                                                                                  29. King AD et al: MR features of the denervated tongue in radiation induced neuropathy. Br J Radiol. 72(856):349-53, 1999
                                                                                  30. Murakami R et al: MR of denervated tongue: temporal changes after radical neck dissection. AJNR Am J Neuroradiol. 19(3):515-8, 1998
                                                                                  31. Murakami R et al: CT and MR findings of denervated tongue after radical neck dissection. AJNR Am J Neuroradiol. 18(4):747-50, 1997
                                                                                  32. Russo CP et al: MR appearance of trigeminal and hypoglossal motor denervation. AJNR Am J Neuroradiol. 18(7):1375-83, 1997
                                                                                  33. Harnsberger HR et al: Major motor atrophic patterns in the face and neck: CT evaluation. Radiology. 155(3):665-70, 1985