PMC6165620_01
Bilateral tongue wasting: (a) resting position; (b) on protrusion.
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Neurological examination revealed bilateral hypoglossal nerve palsy with marked tongue atrophy, more prominent in the left side (Figure 1) with tongue fasciculations and without other cranial nerve palsies or pyramidal weakness.
T1-weighted MRI of brainstem involving medulla oblongata demonstrating an infection: (a) without contrast; (b) postcontrast.
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Subsequently, she underwent MRI of brain and brainstem, which revealed a posteromedial infarction in the lower part of the medulla oblongata without leptomeningeal enhancement and did not show a significant cerebral oedema (Figure 2).