Hypoglossal nerve palsy.

The hypoglossal nerve receives only brief mention in most textbooks and compared with other cranial nerve palsies, 12th nerve palsy is much less common. We report a 52-year-old woman who presented with right-sided headaches for over a year. It was only on examination that we discovered she had an abnormal tongue. She had wasting and fasciculations on the right side of her tongue, which was deviated to the right side, due to the unopposed action of the unaffected left side (Fig 1). The rest of the neurological examination was unremarkable. On further questioning she said she had no problems with speech, mastication, or swallowing. Magnetic resonance imaging confirmed a well-defined mass lesion encroaching on the right side of the foramen magnum and the hypoglossal canal, with displacement of the right medulla and the inferior cerebellar hemisphere (Figs 2, 3). The radiological characteristics suggested bone dysplasia. She was referred for craniectomy and excision but at the time of writing, the patient remained undecided whether to have surgery.