A 43 year old female attended with spontaneous onset of isolated left hypoglossal nerve palsy. The patient was undergoing concurrent treatment for metastatic breast cancer. Magnetic resonance imaging (MRI) investigation revealed a metastatic infiltration of the left occipital bone with encroachment upon the left hypoglossal canal. Isolated hypoglossal nerve palsy is uncommon and upon presentation should be treated with a high level of suspicion.Oral Surgery 12 (2019) 71--74.