Introduction:

Hypoglossal nerve palsy is a rare mononeuropathy. The most common etiologies are tumor, traumatic, cerebral ischemic and iatrogenic causes.

Description:

We present a man with idiopathic hypoglossal nerve neuropathy. The patient's age, the presence of vascular risk factors and cerebral microangiopathy, and the clinical evolution leads us to discussion about the possibility of a ischemic or diabetic mononeuropathy as the etiology of the deficit.

Discussion:

In previous published series of idiopathic hypoglossal nerve palsy, the age of presentation is between 20 and 45 years and the patients have a favorable evolution. The pathophysiological mechanism could be similar to Bell's palsy. In our patient the physical examination and the complementary studies were normal, diagnose the deficit as idiopathic hypoglossal nerve palsy. However, due to patient's age, the presence of multiple vascular risk factors, cerebral microangiopathy and the persistence of the symptoms, we consider the existence of a local ischemic or diabetic damage as the cause of the mononeuropathy presented, and we think that the physiopathological mechanism could be similar to other mononeuropathies, such as III or VI cranial nerve palsy.

Conclusion:

We present an idiopathic hypoglossal nerve palsy, but due to characteristics of our patient, we discuss an ischemic or diabetic cause of the deficit.

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