Differential Diagnosis for Tongue Deviation

The differential diagnosis for tongue deviation can be organized into the following categories:

• Single Most Likely Diagnosis

  • Stroke or cerebral vasculature accident (CVA): This is the most common cause of tongue deviation, resulting from damage to the hypoglossal nerve (cranial nerve XII) or its nucleus in the brainstem, often due to a stroke. The tongue will deviate towards the side of the lesion when protruded.

• Other Likely Diagnoses

  • Hypoglossal nerve palsy: Damage to the hypoglossal nerve, which can occur due to trauma, infection, or tumors, can cause tongue deviation. The symptoms can include difficulty speaking and swallowing.
  • Bell's palsy: Although primarily affecting the facial nerve, in some cases, it can also involve the hypoglossal nerve, leading to tongue deviation.
  • Multiple sclerosis: This chronic autoimmune disease can cause lesions in the central nervous system, potentially affecting the pathways that control tongue movement.

• Do Not Miss Diagnoses

  • Brainstem tumor: Tumors in the brainstem can compress or invade the hypoglossal nerve nucleus or the nerve itself, leading to tongue deviation. Early detection is crucial for treatment and prognosis.
  • Cerebral amyloid angiopathy: This condition involves the deposition of amyloid beta peptides in the blood vessels of the brain, which can lead to hemorrhagic strokes, potentially causing tongue deviation.
  • Moyamoya disease: A rare condition caused by narrowing or blockage of the internal carotid artery and its branches, which can lead to stroke and subsequent tongue deviation.

• Rare Diagnoses

  • Amyotrophic lateral sclerosis (ALS): A progressive neurodegenerative disease that affects nerve cells in the brain and the spinal cord, leading to loss of muscle control. Tongue deviation can be a symptom in advanced stages.
  • Syringobulbia: A condition where a fluid-filled cavity (syrinx) forms within the spinal cord or brainstem, potentially damaging the hypoglossal nerve and causing tongue deviation.
  • Neurosyphilis: A complication of untreated syphilis infection that can affect the central nervous system, including the brainstem, and cause a variety of neurological symptoms, including tongue deviation.