Isolated hypoglossal nerve mononeuropathy associated with preeclampsia in late pregnancy: a case report

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Background: Neurological complications in preeclampsia are uncommon and typically central in origin. Cranial mononeuropathies, especially involving the hypoglossal nerve, are exceedingly rare. Case Presentation: We report a case of isolated hypoglossal nerve mononeuropathy in a 31-year-old primigravida at 37 weeks of gestation with preeclampsia. The patient presented with mild dysphagia and dysarthria. Neurological examination revealed tongue deviation to the right, suggestive of left hypoglossal nerve mononeuropathy. MRI brain with T1/T2, FLAIR and DWI/ADC sequences and MR angiography, followed by contrast enhanced MRI of the neck and oral cavity, showed no infarct, haemorrhage, mass lesion or compressive pathology. The patient was managed conservatively with blood pressure optimisation, and symptoms resolved completely within 90 days postpartum. Conclusion: At least four cases of hypoglossal nerve mononeuropathy associated with preeclampsia have been reported in the literature. This case adds to the emerging evidence that cranial mononeuropathies may represent a rare but important neurological manifestation of preeclampsia and highlights the need for urgent neuroimaging and careful blood pressure control in pregnant and/or postpartum patients presenting with bulbar symptoms.