American Society for Peripheral Nerve

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A Rare Cause of Unilateral Hypoglossal Nerve Palsy: Intraneural Ganglion Cyst of the Hypoglossal Nerve
Jeremie D. Oliver, BS, BA; Vijay Agarwal, MD; Jeffrey Janus, MD; Jamie Van Gompel, MD
Mayo Clinic, Rochester, MN

Introduction: Ganglion cysts causing hypoglossal compression are significantly rare. They are typically found in peripheral nerves near tendon sheaths, often near the carpal tunnel, or in the lower limb region near the fibular head. Cranial nerves are rarely affected by intraneural ganglion cysts. These cysts can become clinically remarkable by causing compression of the adjacent nerve fascicles, resulting in pain, paresthesia, weakness, muscle denervation, and atrophy. Significant clinical findings to be expected from an intraneural ganglion cyst of the hypoglossal nerve include unilateral tongue deviation and atrophy on the affected side, as well as potentially slurred speech. Symptoms of hypoglossal nerve ganglion cysts can also include relevant structures affected in glossopharyngeal nerve or spinal accessory nerve palsies, as these cranial nerves travel alongside the hypoglossal nerve and could potentially become impinged as a result of the ganglion cyst arising on the adjacent hypoglossal nerve. The present literature suggests this to be a significantly rare finding affecting the hypoglossal nerve, with only three previously documented cases being reported.

Materials and Methods: Patient medical record data collection. Review of literature performed using an electronic search using Ovid Medline and PubMed in April 2017 without timeframe limitations. Only English-language citations were considered. The following were used as either keywords or Medical Subject Headings (MeSH) in all combinations in the search strategy: “hypoglossal cyst”, “hypoglossal tumor”, “intraneural ganglion cyst”. The compiled reference lists were compared and reviewed for potential relevance and assessed using the inclusion and exclusion criteria.

Discussion: We report, to our knowledge, the fourth documented case of a patient with a hypoglossal cystic tumor. Our aim in this report is to compare our findings with previous reported cases of unilateral hypoglossal nerve palsy, and to highlight the importance of an intraneural ganglion cyst, and the differential diagnosis of such.

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