Case Overview

A 31-year-old primigravida at 37 weeks’ gestation with preeclampsia presented with mild dysarthria and dysphagia. Neurological examination revealed tongue deviation to the right, consistent with a left hypoglossal nerve palsy.

Extensive neuroimaging—including MRI brain, MR angiography, and contrast-enhanced imaging of the neck—demonstrated no infarction, hemorrhage, mass lesion, or compressive pathology, effectively excluding structural and vascular causes.

Management focused on blood pressure optimization and obstetric care, without nerve-specific therapy. The patient experienced complete resolution of symptoms within 90 days postpartum.

Why This Case Matters

Cranial mononeuropathies in preeclampsia are rare but increasingly recognized. This case reinforces several key clinical insights:

Diagnosis of exclusion: Normal imaging is essential to rule out brainstem stroke, skull base lesions, and vascular pathology
Likely mechanism: Microvascular ischemia, endothelial dysfunction, and vasospasm affecting the vasa nervorum
Favorable prognosis: Most cases resolve spontaneously with control of the underlying hypertensive disorder
Clinical vigilance: Bulbar symptoms in pregnancy should prompt urgent neurological and obstetric evaluation
Clinical Take-Home Message

Isolated cranial neuropathies—including hypoglossal nerve palsy—should be considered a rare but reversible neurological manifestation of preeclampsia, particularly in the presence of severe hypertension and normal neuroimaging.

Question

What is the most likely mechanism underlying hypoglossal nerve involvement in preeclampsia?

A. Direct viral infection of the nerve
B. Autoimmune demyelination
C. Microvascular ischemia due to endothelial dysfunction
D. Compressive tumor at the skull base

Correct Answer:

C. Microvascular ischemia due to endothelial dysfunction
Explanation: Preeclampsia is characterized by systemic endothelial dysfunction and vasospasm, which can impair perfusion of cranial nerves via the vasa nervorum, leading to transient, reversible mononeuropathies.

Final Thoughts

This case is a valuable reminder that not all neurological symptoms in preeclampsia are central. Recognition of reversible peripheral cranial neuropathies can prevent unnecessary interventions and guide appropriate management focused on timely blood pressure control and obstetric care.

Journal of Medical Case Reports is the world’s first international, PubMed-listed, medical journal devoted to publishing case reports from all medical disciplines and will consider any original case report that expands the field of general medical knowledge, and original research relating to case reports.