Physical examination of hypoglossal nerve injury firstly found unilateral or bilateral tongue dyskinesia, followed by lingual muscle atrophy and muscle fascicle fibrillation; the lips are often weak and can not be puffed up, i.e., the use of fingers to press the nostrils closed often still can not puff up the cheeks, can only be puffed up the cheeks in the pressure of closing the mouth and lips. Palatal arch paralysis is also seen, and the sucking reflex disappears. Tongue muscle atrophy with or without tongue muscle tremor, brainstem reflex abnormalities. What causes hypoglossal nerve injury? 1, peripheral hypoglossal nerve injury is mainly caused by peripheral lesions of hypoglossal nerve, the most common causes are skull base fracture, aneurysm, tumor, submandibular injury (gunshot wounds), cervical vertebrae dislocation, occipital condyle fracture, occipital condylar anterior foramen osteochondritis, as well as the base of the skull or the neck when performing surgery, unintentionally or intentionally (e.g., for hypoglossal and facial nerve anastomosis) by the injury, there are also hypoglossal nerve primary tumors. The signs of peripheral hypoglossal nerve damage are basically similar to those of the hypoglossal nucleus, except for unilateral paralysis of the tongue muscle. Bilateral supranuclear paralysis and supranuclear paralysis of tongue muscle on one side can be caused by a variety of causes, but the most common is due to the sequelae of several or several strokes, amyotrophic lateral sclerosis, diffuse cerebral vascular sclerosis, multiple sclerosis, multiple cerebral infarcts, syphilitic cerebral arteritis, medullary cavernous disease, polio, cerebrovascular disease, cerebral hemorrhage, cerebral embolism, intracranial tumors, and cerebral injuries, such as medullary palsy. 3.Nuclear lesion of hypoglossal nerve Vascular lesion of medulla oblongata, medullary cavernous disease, progressive medullary palsy; malformations of craniocervical region, such as cranial base depression, congenital herniation of subcerebellar tonsils; metastatic cancer infiltration of cranial base (e.g. nasopharyngeal carcinoma); lesions near the foramen magnum of the occipital bone, such as tumors, bone fracture, meningitis, neck tumors. Unilateral or bilateral tongue dyskinesia is found during examination, followed by atrophy of the tongue muscle and muscle fasciculation; the lips and mouth are often weak and unable to puff up, i.e., the nostrils can not be puffed up even if the fingers are pressed shut, and the cheeks can only be puffed up when the lips and mouth are pressed shut. Palatal arch paralysis is also seen, and the sucking reflex disappears. Tongue muscle atrophy is accompanied or not accompanied by tongue muscle tremor and abnormal brainstem reflexes.