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, Indian, 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. Magnetic resonance imaging of the brain, including T1/T2-weighted sequences, fluid-attenuated inversion recovery, and diffusion-weighted imaging with apparent diffusion coefficient sequences, and magnetic resonance angiography, followed by contrast-enhanced magnetic resonance imaging of the neck and oral cavity, showed no infarct, hemorrhage, mass lesion, or compressive pathology. The patient was managed conservatively with blood pressure optimization, and symptoms resolved completely within 90 days postpartum. CONCLUSION: At least four cases of hypoglossal nerve mononeuropathy associated with preeclampsia have been reported in 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.

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