Doomed tongue twisters.

To cite: Kim JY, Han SW. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2013-202781 DESCRIPTION Occurrence of hypoglossal nerve palsy (HNP) accompanied with other cranial nerve palsies is not an uncommon finding. However, isolated HNP is a rare finding and represents a diagnostic challenge. Awoman in her late 70 s was referred to the neurology department due to sudden onset of dysarthria. She had right breast cancer in 2003 and underwent mastectomy, local radiotherapy and adjuvant chemotherapy for regional metastasis. On neurological examination her tongue was hemiatrophy and deviated to the left side. The rest of the neurological examination was unremarkable. Brain MRI showed a subtle enhancing lesion involving the left occipital condyle with the destruction of the petrous apex and clivus (figure 1A). The supraclavicular lymph node biopsy showed a metastatic adenocarcinoma (clinically breast ductal carcinoma). In another case, a woman in her mid 60 s visited a hospital due to sudden onset of dysarthria. Medical history was unremarkable. Neurological examination showed atrophy with left-sided tongue deviation. Brain MRI revealed an enhancing lesion involving the left occipital condyle and clivus (figure 1B). The biopsy of regional enlarged lymph node showed the poorly differentiated metastatic squamous cell carcinoma. The hypoglossal nerve is a pure motor nerve responsible for the motor supply to the tongue. Vascular, inflammatory, traumatic or spaceoccupying lesions can affect the hypoglossal nerve anywhere in its course. 2 Isolated HNP is a rare finding because of its proximity to other important anatomical structures throughout its pathway. HNP, when isolated, may be the first sign of a serious underlying disease and a neoplastic aetiology should be excluded. 3