Illustration of a weakened neural pathway affected by cancer.

Unexplained Weakness? When a Silent Cancer Strikes the Nerves

Beau Callahan in Health & Wellness December 2025 • 4 min read.

"Isolated hypoglossal nerve palsy as a rare sign of metastatic peripheral T-cell lymphoma—what you need to know."

Imagine experiencing sudden difficulty speaking, your tongue refusing to cooperate. This unsettling scenario can be the first sign of a rare condition where cancer silently attacks the nerves. Lymphomas, cancers of the lymphatic system, are known for their diverse presentations, often masquerading as other illnesses.

In a recent case, doctors encountered a young man whose initial symptom was isolated hypoglossal nerve palsy—a dysfunction affecting the nerve that controls tongue movement. This unusual presentation turned out to be the first sign of metastatic peripheral T-cell lymphoma (PTCL), a particularly aggressive form of non-Hodgkin lymphoma. His case highlights the importance of vigilance and comprehensive investigation when faced with atypical symptoms.

This article delves into the specifics of this case, exploring how seemingly isolated symptoms can be connected to underlying malignancies. We'll break down the diagnostic process, treatment approaches, and what makes this presentation of PTCL so unique, offering crucial insights for both patients and healthcare professionals.

What is Hypoglossal Nerve Palsy and Why Does it Matter?

Illustration of a weakened neural pathway affected by cancer.

The hypoglossal nerve, or cranial nerve XII, is crucial for controlling the muscles of the tongue, enabling speech, swallowing, and food manipulation. When this nerve is damaged, it leads to hypoglossal nerve palsy, characterized by symptoms such as slurred speech (dysarthria), tongue weakness, and deviation of the tongue to one side upon protrusion.

While many conditions can cause hypoglossal nerve palsy—including infections, stroke, and trauma—its association with cancer, particularly lymphoma, is rare. This rarity makes diagnosis challenging, as clinicians must consider a wide range of possibilities.

Common Symptoms: Slurred speech, difficulty swallowing, tongue weakness or atrophy.
Typical Causes: Stroke, trauma, infections, tumors (less common).
Diagnostic Challenges: Symptoms can mimic other neurological conditions.
Importance of Early Diagnosis: Timely intervention can improve outcomes in cancer-related cases.

The case study we’re examining underscores the need to consider malignancy in the differential diagnosis of hypoglossal nerve palsy, especially when other risk factors or unusual symptoms are present. Missing this connection can significantly delay appropriate treatment, affecting prognosis and survival.

Why This Case Changes the Game

This unique case serves as a critical reminder: cancer can present in unexpected ways. Isolated hypoglossal nerve palsy, though rare, should prompt clinicians to consider a broader differential diagnosis, including lymphoma, especially in younger patients without typical risk factors. The combination of advanced diagnostic techniques and heightened clinical awareness is essential for early detection and improved outcomes. For patients, being informed and proactive about unusual or persistent symptoms can be life-saving.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.2217/ijh-2018-0002, Alternate LINK

Title: Isolated Hypoglossal Nerve Palsy As A Presenting Symptom Of Metastatic Peripheral T-Cell Lymphoma – Not Otherwise Specified (Ptcl–Nos): A Unique Case &Amp; A Review Of The Literature

Subject: Pharmacology (medical)

Journal: International Journal of Hematologic Oncology

Publisher: Future Medicine Ltd

Authors: Emily Bryer, David Henry

Published: 2018-03-01

Everything You Need To Know

What is hypoglossal nerve palsy, and how does it impact daily functions?

Hypoglossal nerve palsy is a condition resulting from damage to the hypoglossal nerve (cranial nerve XII). This nerve controls the muscles of the tongue, and when it's impaired, it leads to symptoms like slurred speech (dysarthria), difficulty swallowing, and tongue weakness. Patients may also experience the tongue deviating to one side upon protrusion, impacting their ability to speak clearly, swallow effectively, and manipulate food in the mouth. The condition may result in other underlying neurological issues, so it is vital to seek counsel with a medical professional.

What are the common causes of hypoglossal nerve palsy, and why is it challenging to diagnose when linked to cancer?

The common causes of hypoglossal nerve palsy include stroke, trauma, infections, and, less frequently, tumors. Diagnosing hypoglossal nerve palsy is challenging when linked to cancer because its association with malignancies like lymphoma is rare, which can lead clinicians to initially consider more common neurological conditions. This rarity, coupled with the diverse range of potential causes, necessitates a comprehensive diagnostic approach to avoid delays in identifying cancer-related cases. Missing the cancer association could delay appropriate treatment, adversely affecting patient prognosis and survival.

In the context of metastatic peripheral T-cell lymphoma (PTCL), how might hypoglossal nerve palsy serve as an initial indicator, and why is this presentation considered unique?

In the context of metastatic peripheral T-cell lymphoma (PTCL), hypoglossal nerve palsy can serve as an initial, though rare, indicator of the disease. This presentation is considered unique because lymphomas typically manifest with more common symptoms, such as swollen lymph nodes, fatigue and weight loss. The case highlights the importance of considering less typical manifestations of cancer, as early detection and intervention are crucial for improving outcomes in aggressive lymphomas like PTCL. Vigilance and comprehensive investigation are essential when faced with atypical symptoms.

What diagnostic steps are crucial when hypoglossal nerve palsy is suspected, and how can they help differentiate between various potential causes, including rare malignancies like lymphoma?

When hypoglossal nerve palsy is suspected, crucial diagnostic steps include a thorough neurological examination, imaging studies such as MRI to visualize the nerve and surrounding structures, and potentially a biopsy if a mass or lesion is detected. In cases where malignancy is suspected, further investigations like a complete blood count, bone marrow biopsy, and lymph node biopsy may be necessary to confirm the presence and extent of lymphoma. These steps help differentiate between common causes like stroke or infection and rarer causes like metastatic peripheral T-cell lymphoma (PTCL).

What implications does the case of isolated hypoglossal nerve palsy linked to metastatic peripheral T-cell lymphoma have for both clinicians and patients in terms of awareness and proactive healthcare management?

The case of isolated hypoglossal nerve palsy linked to metastatic peripheral T-cell lymphoma (PTCL) underscores the need for heightened clinical awareness among healthcare professionals, prompting them to consider malignancy in the differential diagnosis of unusual neurological symptoms. For patients, it emphasizes the importance of being proactive about reporting any persistent or unexplained symptoms to their doctors. Additionally, it highlights the importance of seeking second opinions or consulting with specialists when initial diagnoses don't fully explain their symptoms. The case is a reminder that early detection, through a combination of informed patients and vigilant clinicians, is essential for improved outcomes.