Many cases of sixth nerve palsy are temporary as with diabetes and will resolve in a few weeks or months. Eye patches, glasses, corticosteroids, andor botulinum toxin may be used to ease symptoms. Hypoglossal nerve palsy hypoglossal nerve disorder. Isolated hypoglossal nerve palsy is rare due to its complex course and close proximity to other cranial nerves and vessels. The deceptively simple sixth nerve palsy american academy. Removal of the impacted tooth resulted in the improvement of function of the. More commonly, the hypoglossal nerve is involved along with the glossopharyngeal, vagus, and spinal accessory nerves within the nearby jugular foramen. Persistent isolated unilateral hypoglossal nerve palsy. Hypoglossal nerve palsy after airway management for. The next common cause proved to be metastatic disease at the base of the skull in three patients. This material will help you understand fourth nerve palsy and how it is treated. The hypoglossal nerve cranial nerve xii supplies motor innervation to the muscles of the tongue. Cn iii oculo motor, cn iv trochlear, and cn vi abducens. Sixth nerve palsy genetic and rare diseases information.
Having said that though, hypoglossal nerve palsy ie paralysis of the muscles supplied by the hypoglossal nerve is well recognised complication of. Oculomotor nerve palsy dr ahmed abdrabou and assoc prof frank gaillard et al. A patients history of coronary artery disease, myocardial infarction, stroke, and smoking should be considered. The 12th cranial nerve makes it possible to move the tongue muscles. Fourth cranial nerve palsy in a collegiate lacrosse player. Medial rectus, inferior rectus and inferior oblique subnuclei. Orthoptic department information sheet symptoms sixth vi. The pathway of the facial nerve is long and relatively convoluted, so there are a number of causes that may result in facial nerve paralysis. Hypoglossal nerve injury can cause considerable dysarthria, dysphagia, and even represents a potential source of airway compromise, particularly in bilateral lesions. The hypoglossal nerve may be connected anastamosed to the facial nerve to attempt to restore function when the facial nerve is damaged. Double vision is when you see two of a single imageeither side by side, or one above the other. Facial nerve palsy is the name given to the medical condition where the muscles to one side of the face become weak and partially or completely paralysed. Facial nerve palsy can be distinguished from a central facial nerve lesion eg, due to hemispheric stroke or tumor, which causes weakness primarily of the lower face, sparing the forehead muscle and allowing patients to wrinkle their forehead.
Isolated unilateral hypoglossal nerve palsy neurology and. This may result in horizontal double vision diplopia with in turning of the eye and decreased lateral movement. Nuclear or infranuclear lesions produce paralysis, atrophy, and fasciculations of the tongue on the involved side. Abducens nerve paralysis, botilinum toxin, diplopia. Damage to the hypoglossal nucleus or hypoglossal nerve can cause denervation atrophy of the tongue, as seen in this patient. Eyeassociated multiple cranial nerve palsies medcrave. Disorders of the 12th cranial nerve hypoglossal nerve cause weakness or wasting atrophy of the tongue on the affected side. Isolated hypoglossal nerve palsy in a child article pdf available in the turkish journal of pediatrics 461. We report nine patients with hypoglossal nerve palsy as the sole neurological manifestation, without simultaneous involvement of other cranial nerves or longtract signs.
The nerve has a purely somatic motor function, innervating all the extrinsic and intrinsic muscles of the tongue except the palatoglossus, innervated by vagus nerve in this article, we shall look at the anatomy of the hypoglossal. The most common cause of sixth nerve palsy is believed to be a microvascular insult, and vasculopathic risk factors include diabetes, hypertension, and hypercholesterolemia. Cn i olfactory, cn ii optic, cn iii oculomotor, cn iv trochlear, cn v trigeminal, cn vi abducens, cn vii facial, cn viii vestibulocochlear, cn ix glossopharyngeal, cn x vagus, cn xi. We present a case where a patient presented herself with swelling on the right side of her cheek extending to the floor of the mouth, with unilateral right hypoglossal nerve palsy. Botilinum injection can help patients with sixth nerve palsy during the recovery period. Supranuclear lesions produce mild to moderate contralateral weakness that may be transient. A sixth nerve palsy, also known as abducens nerve palsy, is a neurological defect resulting from an impaired sixth nerve or the nucleus that controls it. Isolated unilateral hypoglossal nerve palsy due to vertebral. Hypoglossal nerve an overview sciencedirect topics. Trauma usually causes bilateral 4th nerve palsies due to an impact in the area of the anterior medullary vellum, where the two nerves decusate.
Hypoglossal nerve the hypoglossal nerve is the twelfth cranial nerve xii, leading to the tongue. Trapezius, spinal accessory nerve, palsy, winging scapula, idiopathic. Review of a series with abducens nerve palsy turkish neurosurgery. The nerve arises from the hypoglossal nucleus and emerges from the medulla oblongata in the preolivary sulcus separating the olive and the pyramid. Hypoglossal nerve injury may occur despite correct. Isolated unilateral hypoglossal nerve palsy hnp is uncommon with only a few casereports and two case series in literature. Our study is the largest case series including12 patients. The hypoglossal nerve receives only brief mention in most textbooks and compared with other cranial nerve palsies, 12th nerve palsy is much less common.
Hypoglossal nerve palsy exits the medulla oblongata, extends through the skull base, and traverses the suprahyoid neck before ramifying to supply the tongue musculature. Nonetheless, assessment of clinical status and consideration of the acuity of lesions can help determine the urgency of repair. It has the longest subarachnoid course of all the cranial nerves. A case from 2007 suggested that isolated hypoglossal nerve palsy is an ominous sign and in their patient represented palsy secondary to a metastatic skull base deposit 5. Cases of persistent idiopathic isolated hypoglossal nerve palsy are extremely rare, one similar case documenting only one other documented case in the literature. Thus, damage to this nerve will result in the affected individual being unable to. Idiopathic isolated unilateral hypoglossal nerve palsy is a rarely observed finding in clinical practice.
The clinical examination is the principal method by which hypoglossal nerve palsy can be detected, but imaging studies, either computed tomography or magnetic. It was only on examination that we discovered she had an abnormal tongue. The nerve can be transected during trauma or surgery but there are also several reports in the otolaryngology, anesthesia, and neurology literature concerning iatrogenic hypoglossal nerve palsy without direct nerve injury following tonsillectomy, 1,2 laryngoscopy, 3 transoral intubation, 4 use of the laryngeal mask airway lma 5 tooth. The hypoglossal nerve is one of the least injured nerves in head injury. Oculomotor nerve palsy an overview sciencedirect topics. These functions includeeye movements, swallowing, facial sensation, and other facial movements. This will lead to the proper treatment of the sixth nerve palsy. Oculomotor nerve palsy radiology reference article. Iatrogenic hypoglossal nerve palsy practical neurology. Palsies of cranial nerves iii, iv, and vi are rare in childhood, with an estimated incidence of 7.
The workup for a sixth nerve palsy includes blood test, mri, and workup by a neuroophthalmologist or neurologist to determine the cause. Case of isolated hypoglossal nerve palsy is an extremely rare condition. Orthoptic department information sheet third iii nerve palsy. The hypoglossal nerve cn xii is the motor nerve of the tongue. The hypoglossal nerve is the twelfth paired cranial nerve its name is derived from ancient greek, hypo meaning under, and glossal meaning tongue. Oculomotor nerve palsies, or third nerve palsies, result in weakness of the muscles supplied by the oculomotor nerve, namely the superior rectus, inferior rectus, medial rectus, inferior oblique, and levator palpebrae superioris muscles.
The full text of this article is available in pdf format. A healthy 67yearold female was scheduled for a hallux valgus correction under general anesthesia combined with femoral and sciatic nerve blocks. The nerve arises from the hypoglossal nucleus in the medulla as a number of small rootlets, passes through the hypoglossal canal and down through the neck, and. Apart from a case series of 100 subjects in 1996 and several small cohorts, there have been no large retrospective series of cranial nerve xii cn xii palsy. Orthoptic department information sheet symptoms sixth vi nerve palsy we are committed to making our publications as accessible as possible. When it is damaged, or functions improperly, the result is loss of tongue muscle function. Hypoglossal nerve palsy after use of the laryngeal mask airway lma is an exceptionally rare complication. Isolated hypoglossal nerve paralysis is an uncommon cranial nerve palsy. Facial nerve palsy symptoms 7th cranial nerve, function.
Unilateral hypoglossal nerve palsy after use of the laryngeal. Vascular, inflammatory, traumatic, or spaceoccupying lesions can affect the cn xii anywhere in its course, from the nucleus in the caudal medulla, through the intracranial extramedullary portion of the nerve, across the hypoglossal canal, or into its extracranial termination. There are several causes that can be attributed to it. Thirdnerve palsy from a posterior communicating artery, posterior cerebral artery, or superior cerebellar artery aneurysm has been recorded. Isolated hypoglossal nerve palsy hnp, or neurapraxia, a rare postoperative complication after airway management, causes ipsilateral tongue deviation, dysarthria, and dysphagia. Facial nerve paralysis is a common problem that involves the paralysis of any structures innervated by the facial nerve. We report a 52yearold woman who presented with rightsided headaches for over a year. Oculomotor nerve palsy is an eye condition resulting from damage to the third cranial nerve or a branch thereof. The hypoglossal nerve descends between the internal carotid artery ica and the internal jugular vein ijv in the nasopharyngeal carotid space to the level of the transverse process of the atlas, where it turns forward along the lateral surface of the ica and the external carotid artery eca, entering the digastric triangle of the neck. Two exceptional causes were chiari malformation in one case. Although the eyes can move when sleeping, they dont regain the weakness to move against a weak muscle seen in a 6th nerve palsy. Attempts at repair by either wholly or partially connecting nerve fibres from the hypoglossal nerve to the facial nerve may be used when there is focal facial nerve damage for example, from trauma or cancer. Pdf unilateral hypoglossal nerve palsy after use of the laryngeal.
As a result, you may not be able to move your eye a certain way. The fibers of the hypoglossal nerve arise in the hypoglossal nuclei, which extend through the medulla oblongata in a paramedian location. Sixth nerve palsy is a disorder that affects eye movement. The hypoglossal nerve is used for daily functions most people take for granted, like eating and speech. Oct 08, 2019 trochlear nerve palsy is mentioned in ophthalmology texts dating to the mid nineteenth century. The primary function of the sixth cranial nerve is to send signals to your lateral. Isolated hypoglossal nerve palsy due to infected impacted tooth. We describe a patient with an isolated hypoglossal nerve palsy caused by an ar. Oct 16, 2015 sixth nerve palsy may be caused by many things, including stroke, brain aneurysm, diabetic neuropathy, trauma, infections, inflammation, tumors, migraine headaches or intracranial pressure. The hypoglossal nerve is the twelfth cranial nerve, and innervates all the extrinsic and intrinsic muscles of the tongue, except for the palatoglossus which is innervated by the vagus nerve. Nov 22, 2019 microvascular cranial nerve palsy mcnp is when blood flow to certain nerves in your head called cranial nerves is blocked. Oculomotor nerve palsy due to closed head injury is uncommon 5% to 15%. Robaina bordon and others published isolated hypoglossal nerve palsy find, read and cite all the research you need on researchgate. There are 12 pairs of nerves cranial nerves that control most of the functions of the head and neck.
Isolated unilateral hypoglossal neuropathy caused by dural. However, it received little more than a brief mention and was no doubt an underrecognized entity. Abducens nerve palsy sixth cranial nerve palsy clinical. Hypoglossal nerve disorders brain, spinal cord, and nerve. The hypoglossal nerve is the twelfth and last cranial nerve and supplies the tongue with motor control. Hypoglossal nerve palsy is an uncommon neurological deficit characterized by unilateral weakness andor atrophy of the tongue that may arise due to trauma, iatrogenic causes eg. If you need this document in an alternative format, for example, large print, braille or a language other than english, please contact the communications office by.
Facial nerve palsy merck manuals professional edition. An overview of the third, fourth and sixth cranial nerve palsies. Anatomy the third cranial nerve supplies the levator muscle of the eyelid and four extraocular muscles. It allows control of the tongue for such things as mixing food you have eaten into a ball. Hypoglossal nerve palsy medigoo health medical tests. Hypoglossal nerve palsy after use of the laryngeal mask airway lma is an exceptionally rare. Hypoglossal nerve disorders may be caused by tumors, strokes, infections, injuries, or amyotrophic lateral sclerosis. See third cranial nerve oculomotor nerve palsy in children and overview of diplopia and overview of ptosis and approach to the patient with anisocoria. The palsy may result from injury in the brain stem affecting the fourth nerve nucleus or fascicle. We present the first case of unilateral hypoglossal nerve palsy after use of the lma supreme. The oculomotor nerve exits the midbrain into the interpeduncular fossa after its rootlets traverse the red nucleus. Nov 19, 2018 cranial nerve vi, also known as the abducens nerve, innervates the ipsilateral lateral rectus lr, which functions to abduct the ipsilateral eye.