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This neurofibroma of the hypoglossal nerve is a rare lesion compared to the tumors of the 8th and 10th cranial nerves. Just as the latter may grow to a great size before being noticed because of pressure symptoms, so did this one apparently compress the medulla oblongata for a long time before it became apparent. Apparently the first signs had to do with compression of autonomie pathways in the medulla oblongata, accounting for the pupillary changes and the sudomotor changes in the right half of the body. The headaches, made worse by bending of the neck, are to be ascribed to pressure at the foramen magnum. The deviation and fibrillation of the tongue are pathognomonic of a nuclear lesion of the 12th nerve and should point directly to this area. The lesions that might be responsible for such a finding include tumor; syringobulbia; bulbar form of amyotrophic lateral sclerosis, although
Sugar O. COMMENT. JAMA. 1955;158(3):184. doi:10.1001/jama.1955.02960030034010a