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Isolated hypoglossal nerve palsy (HNP) presents with ipsilateral tongue deviation due to atrophy of the tongue musculature.1 Isolated HNP is rare due to its close proximity to other cranial nerves and long anatomical course. Unilateral lesions usually suggest space-occupying lesions while bilateral involvement is usually due to nerve degeneration or demyelination.2 Plasma cell neoplasms may affect the skull base producing a range of cranial nerve palsies including HNP, with up to 30% of those affected subsequently developing multiple myeloma (MM).3 Prompt recognition of this important differential diagnosis of HNP is important for effective patient management.
A 56-year-old man presented with a 4-day history of right-sided tongue deviation with numbness. …