Tongue Deviation in a Man with Alcoholism: Diagnosis and Discussion

The patient presented in the case “Tongue Deviation in a Man with Alcoholism” (JW Neurol Jan 20 2009) had a right carotid dissection and a large infarct in the right hemisphere. The clue was that the tongue deviated to the right (away from the hemiparesis). The cause of the deviation was a right hypoglossal nerve injury. This nerve can be injured in carotid dissection, because it wraps around the carotid sheath.

A total of 68 readers submitted diagnoses (to see individual responses, click here); 23 of these were correct. The most common incorrect diagnosis was medial medullary syndrome. The hypoglossal nerve is adjacent to the pyramid in the medulla. However, the photograph shows that the patient had left lower facial weakness, which is not …