Unilateral Hypoglossal Nerve Injury in a Collegiate Wrestler: A Case Report

Abstract

Objective: To introduce the case of a collegiate wrestler who suffered a traumatic unilateral hypoglossal nerve injury. This case presents the opportunity to discuss the diagnosis and treatment of a 20-year-old man with an injury to his right hypoglossal nerve.Background: Injuries to the hypoglossal nerve (cranial nerve XII) are rare. Most reported cases are the result of malignancy, with traumatic causes less common. In this case, a collegiate wrestler struck his head on the wrestling mat during practice. No loss of consciousness occurred. The wrestler initially demonstrated signs and symptoms of a mild concussion, with dizziness and a headache. These concussion symptoms cleared quickly, but the athlete complained of difficulty swallowing (dysphagia) and demonstrated slurred speech (dysarthria). Also, his tongue deviated toward the right. No other neurologic deficits were observed.Differential Diagnosis: Occipital-cervical junction fracture, syringomyelia, malignancy, iatrogenic causes, cranial nerve injury.Treatment: After initial injury recognition, the athletic trainer placed the patient in a cervical collar and transported him to the emergency department. The patient received prednisone, and the emergency medicine physician ordered cervical spine plain radiographs, brain computed tomography, and brain and internal auditory canal magnetic resonance imaging. The physician consulted a neurologist, who managed the patient conservatively, with rest and no contact activity. The neurologist allowed the patient to participate in wrestling 7 months after injury.Uniqueness: To our knowledge, no other reports of unilateral hypoglossal nerve injury from relatively low-energy trauma (including athletics) exist.Conclusions: Hypoglossal nerve injury should be considered in individuals with head injury who experience dysphagia and dysarthria. Athletes with head injuries require cranial nerve assessments.

Isolated Hypoglossal Nerve Palsy Due to Endovascular Treatment of a Dural Arteriovenous Fistula with Onyx-18

“…The literature on medication of this complication is lacking, Loro et al suggested prednisolone was effective for hypoglossal nerve palsy due to trauma 9 , this was a reference for our pharmacotherapy. In summary, we should avoid over embolization with Onyx in the treatment of hypoglossal canal DAVFs, and prednisolone should be given in the prophase of nerve palsy.…”

Hypoglossal Nerve Lesions: The Role of a 3D IR‐Prepped Fast SPGR High‐Resolution 3T MRI Sequence

“…It is mainly filled with a venous plexus, which travels through the internal segment of the hypoglossal nerve; in addition, the meningeal branches of the ascending pharyngeal artery also travel through the hypoglossal canal. Previous studies have described the hypoglossal canal and its inner structures, including the shape and size of the bony structures 1‐4,8,14,15,19‐21 …”

“…Interestingly, Fokkema et al found that the hypoglossal nerve is the most frequently involved in patients with cranial nerve lesions 4 . The causes of peripheral hypoglossal nerve lesions include metastatic tumors, direct invasion of extracranial malignant tumors, primary central nervous system tumors (eg, myeloma, jugular glomus tumor, paraganglioma, neurogenic tumor, and meningioma), vascular malformation, and infections 1,5‐13 …”

Changes in localized arrangement into the hypoglossal nucleus after the neurectomy of unilateral hypoglossal nerve (medial branch) in cats

“…Since patients with the neurotomy of the hypoglossal nerve cannot move the tongue at the site of the transected nerve, during tongue protrusion they deviate toward the section site with atrophy of the half tongue (Wilson-Pauwels et al 1988). However, after some months or years followed by tongue rehabilitation, they gain recognition for the visible recovery trend in the atrophy half (Loro and Owens 2009). How do they recover the mechanism?…”