Bilateral Hypoglossal Nerve Palsy Due To Breast Cancer Skull Base Metastases

Despite advances in endocrine therapy and chemotherapy, metastatic disease ultimately develops in about 30% of women diagnosed with early-stage breast cancer. Critical locations of bone metastases may result in specific symptoms. Metastases to the calvarium have the potential to cause cranial nerve palsies. While there have been isolated case reports of unilateral cranial nerve XII palsy, bilateral hypoglossal nerve palsy has never been reported. We report the first known case of bilateral hypoglossal nerve palsy in a 49-year-old woman with estrogen receptor- positive/progesterone receptor-positive, HER2/ neu-negative metastatic breast cancer. The patient underwent palliative radiation therapy with near complete resolution of symptoms. When a patient with metastatic cancer develops unusual neurological symptoms, a high index of suspicion for skull base disease must be maintained, and local therapy can improve quality of life.