Damage to the hypoglossal nerve is a relatively uncommon cranial nerve palsy. Possible causes include tumours and penetrating traumatic injuries. If the symptoms are accompanied by acute pain, a possible cause may be dissection of the internal carotid artery.ig 1.0 – The extracranial anatomical course of the hypoglossal nerve. The hypoglossal nerve arises from the hypoglossal nucleus in the medulla oblongata of the brain. It then passes laterally across the posterior cranial fossa, within the subarachnoid space. The nerve exits the cranium via the hypoglossal canal.