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Hypoglossal Nerve Disorders

By Michael Rubin, MDCM, Professor of Clinical Neurology, Weill Cornell Medical College; Attending Neurologist and Director, Neuromuscular Service and EMG Laboratory, New York Presbyterian Hospital-Cornell Medical Center

Disorders of the 12th cranial nerve (hypoglossal nerve) cause weakness or wasting (atrophy) of the tongue on the affected side. This nerve moves the tongue.

Causes of hypoglossal nerve disorders include

  • A tumor or bone abnormality at the base of the skull

  • A stroke

  • Infection of the brain stem

  • An injury to the neck, as may occur after surgical removal of a blockage from an artery in the neck (endarterectomy)

  • Amyotrophic lateral sclerosis (Lou Gehrig disease)


The tongue becomes weak on the affected side and eventually wastes away (atrophies). As a result, people have difficulty speaking, chewing, and swallowing. Damage due to amyotrophic lateral sclerosis causes tiny, subtle twitching movements (fasciculations) on the surface of the tongue.


  • Magnetic resonance imaging

  • Sometimes a spinal tap

Magnetic resonance imaging (MRI) is usually done to look for a tumor or evidence of a stroke.

A spinal tap (lumbar puncture) may be necessary if cancer or infection is possible.


  • Treatment of the cause

Treatment depends on the cause.