Hypoglossal nerve paralysis revealing type 2 diabetes mellitus: a case report

Abstract

Isolated paralysis of the hypoglossal nerve is rare, and the etiologic diagnosis is often difficult. We report the case of cranial nerve XII revealing type 2 diabetes.

Case presentation: A 68–Year old man with a past history of long–standing hypertension, treated with ramipril 10 mg daily plus hydrochlorothiazide 12.5 mg daily, consulted for speech and difficulties chewing. Clinical examination was remarkable for dysphonia, amyotrophy of the right tongue with fasciculations, and right deviation with retraction. These were diagnostic of an isolated cranial nerve XII paralysis. Laboratory analysis showed hyperglycémia. MRI of the brain stem was normal. He was treated with metformin, with no motor recovery at six months. However, there was mild speech improvement with re-education.

Conclusion: Isolated paralysis of the hypoglossal nerve is a rare peripheral neuropathy in diabetes. In most cases, it is due to brain stem lesions.

Keywords: Lingual paralysis, Hypoglossal Nerve, Diabetes