Presentation
Patient complained of deviation of the tongue to the right side and difficulty in pronunciation for more than 2 years
Patient Data
On MRI, the affected right side of the tongue has high signal on both T1WI and T2WI, suggesting fatty infiltration as a consequence of longstanding denervation of the hypoglossal nerve. Right hemiatrophy and deviation of the tongue to the right side are also seen. Otherwise head and neck MRI is normal. Brain MRI shows no abnormality as well.
Case Discussion
Unilateral atrophy of the tongue is the most important radiologic feature of hypoglossal nerve paralysis. When it is identified, thorough assessment of the hypoglossal nerve from brainstem to the tongue should be performed.
In acute hypoglossal nerve palsy:
- tongue deviation toward the weak side
- oedematous change (T1WI hypointense, T2WI hyperintense)
In chronic hypoglossal nerve palsy:
- tongue deviation toward the weak side
- tongue atrophy (volume loss)
- fatty infiltration (both T1WI and T2WI hyperintense)
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