A 13-year-old male patient presented with acute symptoms of rhinolalia and nasal regurgitation. He reported no trauma, recent infections, or other relevant personal history. Examination revealed unilateral left-sided velopalatine hemiparesis (HPH), with hypomotility of the left soft palate and a right-sided deviation of the uvula (see Figure 1). He had no sensory or motor disturbances at other levels.
A cranial MRI was performed, which ruled out central nervous system disorders, including cranial nerves. A complete blood count and biochemical analysis were normal, and serologic tests (Borrelia, Mycoplasma, Chlamydia, VZV, HSV, parvovirus B19, EBV, CMV, toxoplasmosis, poliomyelitis, rubella, mumps) were negative.
Empirical corticosteroid treatment with prednisone was initiated for 5 days, followed by tapering. Follow-up revealed complete resolution of the symptoms (see Figure 2).
Given negative complementary studies and a favorable clinical course, the diagnosis is compatible with idiopathic PVH. This is a rare entity with sudden onset, mostly unilateral, transient, and benign. It occurs predominantly in boys aged 5–15 years. The typical triad consists of rhinolalia, nasal regurgitation, and uvular deviation. The diagnosis is based on exclusion, ruling out other causes such as surgery, tumors, or neuromuscular pathology. Recovery is usually complete.
