Misdiagnosis: Hypoglossal palsy mimicking bulbar onset amyotrophic lateral sclerosis

Bulbar onset amyotrophic lateral sclerosis (bALS) is a currently incurable neurodegenerative condition characterized by insidious progression of bulbar muscle paresis; namely dyspnea, dysarthria, and dysphagia. The diagnosis of bALS requires exclusion of mimicking pathologies as the diagnosis of bALS may have significant implications on patients' quality of life, future planning, and familial/social dynamics. Herein we present two cases which were misdiagnosed as bALS when in fact a structural lesion of the hypoglossal nerve was causative. This article may serve as a reminder to entertain alternative diagnoses prior to arriving at a diagnosis of bALS.