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Hypoglossal palsy from an atlanto-axial synovial cyst
  1. David Vaughan1,
  2. Sinead M Murphy1,2,
  3. Michael D Alexander2,3,
  4. Richard A Walsh1,2
  1. 1Department of Neurology, Tallaght University Hospital, Dublin, Ireland
  2. 2Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland
  3. 3Department of Neurophysiology, Tallaght University Hospital, Dublin, Ireland
  1. Correspondence to Dr David Vaughan, Department of Neurology, Tallaght University Hospital, Tallaght, D24 NR0A Dublin 24, Ireland; david.vaughan{at}

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A 63-year-old man had a 5-week history of a constant right-sided pulsating headache that was initially temporo-parietal but migrated to the suboccipital area. This was associated with new-onset of dysarthria. On examination, there was deviation of the tongue to the right, and the right-side had a wasted surface appearance, despite what he described as ‘wave-like’ prominence when looking at his tongue in the mirror (figure 1A). The remaining examination was normal.

Figure 1

Clear right-sided tongue deviation on protrusion with right-sided wasting (A). Electromyography showing myokymia, comprising highly polyphasic units suggesting mild-to-moderate partial denervation of the right side of the tongue (B).

Routine laboratory tests and erythrocyte sedimentation rate were normal. MR scan of brain and internal auditory meatuses showed a cystic lesion in the right hypoglossal canal, appearing to abut the right 12th cranial nerve and …

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  • Contributors DV wrote the first draft. RAW and SMM provided revisions. MDA provided the EMG image.

  • Funding No funding was obtained for this case report.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned. Externally peer reviewed by Tom Hughes, Cardiff, UK.

  • Data sharing statement All data relevant to the study are included in the article.