Oral ulcerations as the first sign of a foramen magnum meningioma

We report the case of a patient with oral ulcerations that were likely trau matic in origin caused by biting of the tongue. Physical examination showed only deviation, fasciculations, and hemiatrophy of the right side of the t ongue. Neurologic examination disclosed an isolated XII nerve palsy. A magn etic resonance image showed a lesion in the posterior fossa displacing the brain stem at a bulbar level. This was consistent with the diagnosis of a m eningioma, later confirmed by the histopathologic study. It is very unusual that a meningioma produces a selective involvement of the XII nerve. Early diagnosis of a foramen magnum meningioma is important, both to improve pro gnosis and to avoid neurologic sequelae.