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Santos DA, Costa FO, Dourado HN, Ferreira JA, Castro-Lima H. Teaching Video NeuroImage: Isolated Undulating Tongue Hyperkinesia Following a Basilar Stroke. Neurology 2024; 102:e208079. [PMID: 38165302 DOI: 10.1212/wnl.0000000000208079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/26/2023] [Indexed: 01/03/2024] Open
Abstract
An 82-year-old man with a history of hypertension and coronary revascularization presented with sudden-onset right hemiparesis and disorientation lasting 5 hours. On admission, he was intubated because of gasping and a Glasgow Coma Scale of 3. Hemorrhagic stroke was suspected, but ruled out by the initial head CT, which revealed old cerebellar lacunae. The following day, the comatose, now unsedated patient exhibited tetraparesis; fixed, nonreactive pupils; and corneal reflex, but no oculocephalic reflex. Rhythmic undulating tongue movements without palatal or limb involvement were first observed (Video 1). EEG revealed no epileptiform activity. Follow-up head CT showed acute ischemic lesions in the thalamocapsular region, midbrain, and pons while angiotomography revealed distal basilar artery occlusion (Figure). Involuntary tongue movements, though rare, have been associated with various conditions such as stroke, trauma, and epilepsy.1,2 These movements may result from disinhibition within the inhibitory reticular formation projecting to hypoglossal neurons, suggesting the pontine reticular formation as a central pacemaker.2.
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Affiliation(s)
- Daniel A Santos
- From the Neuroscience Center (D.A.S., F.O.C., H.N.D., H.C.-L.), Bahiana School of Medicine and Public Health, Salvador; Departments of Neurology (D.A.S., F.O.C.) and Radiology (J.A.F.), Suburban Hospital, Salvador, Bahia, Brazil
| | - Felipe O Costa
- From the Neuroscience Center (D.A.S., F.O.C., H.N.D., H.C.-L.), Bahiana School of Medicine and Public Health, Salvador; Departments of Neurology (D.A.S., F.O.C.) and Radiology (J.A.F.), Suburban Hospital, Salvador, Bahia, Brazil
| | - Henrique N Dourado
- From the Neuroscience Center (D.A.S., F.O.C., H.N.D., H.C.-L.), Bahiana School of Medicine and Public Health, Salvador; Departments of Neurology (D.A.S., F.O.C.) and Radiology (J.A.F.), Suburban Hospital, Salvador, Bahia, Brazil
| | - Jackson A Ferreira
- From the Neuroscience Center (D.A.S., F.O.C., H.N.D., H.C.-L.), Bahiana School of Medicine and Public Health, Salvador; Departments of Neurology (D.A.S., F.O.C.) and Radiology (J.A.F.), Suburban Hospital, Salvador, Bahia, Brazil
| | - Humberto Castro-Lima
- From the Neuroscience Center (D.A.S., F.O.C., H.N.D., H.C.-L.), Bahiana School of Medicine and Public Health, Salvador; Departments of Neurology (D.A.S., F.O.C.) and Radiology (J.A.F.), Suburban Hospital, Salvador, Bahia, Brazil
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2
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Uneoka S, Kobayashi T, Numata-Uematsu Y, Oikawa Y, Katata Y, Okubo Y, Abe Y, Kikuchi A, Takayama J, Tamiya G, Kure S, Saito K, Uematsu M. A Case Series of Patients With MYBPC1 Gene Variants Featuring Undulating Tongue Movements as Myogenic Tremor. Pediatr Neurol 2023; 146:16-20. [PMID: 37392669 DOI: 10.1016/j.pediatrneurol.2023.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 04/18/2023] [Accepted: 06/06/2023] [Indexed: 07/03/2023]
Abstract
Myosin-binding protein C1 (MYBPC1) encodes myosin-binding protein C, slow type (sMyBP-C), an accessory protein that regulates actomyosin cross-linking, stabilizes thick filaments, and modulates contractility in muscle sarcomeres and has recently been linked to myopathy with tremor. The clinical features of MYBPC1 mutations manifesting in early childhood bear some similarities to those of spinal muscular atrophy (SMA), such as hypotonia, involuntary movement of the tongue and limbs, and delayed motor development. The development of novel therapies for SMA has necessitated the importance of differentiating SMA from other diseases in the early infancy period. We report the characteristic tongue movements of MYBPC1 mutations, along with other clinical findings, such as positive deep tendon reflexes and normal peripheral nerve conduction velocity testing, which could help in considering other diseases as differential diagnoses.
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Affiliation(s)
- Saki Uneoka
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Tomoko Kobayashi
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan; Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | | | - Yoshitsugu Oikawa
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Yu Katata
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Yukimune Okubo
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Yu Abe
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Atsuo Kikuchi
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan; Department of Rare Disease Genomics, Tohoku University School of Medicine, Sendai, Japan
| | - Jun Takayama
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan; Department of Rare Disease Genomics, Tohoku University School of Medicine, Sendai, Japan; Department of AI and Innovative Medicine, Tohoku University School of Medicine, Sendai, Japan; Statistical Genetics Team, RIKEN Center for Advanced Intelligence Project, Tokyo, Japan
| | - Gen Tamiya
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan; Department of Rare Disease Genomics, Tohoku University School of Medicine, Sendai, Japan; Department of AI and Innovative Medicine, Tohoku University School of Medicine, Sendai, Japan; Statistical Genetics Team, RIKEN Center for Advanced Intelligence Project, Tokyo, Japan
| | - Shigeo Kure
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Kayoko Saito
- Institute of Medical Genetics, Tokyo Women's Medical University, Tokyo, Japan
| | - Mitsugu Uematsu
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
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3
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Patel K, Tappuni A. Rare presentation of essential lingual myoclonus. Neurol Clin Pract 2018; 8:352-353. [DOI: 10.1212/cpj.0000000000000479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 03/28/2018] [Indexed: 11/15/2022]
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Baizabal-Carvallo JF, Cardoso F, Jankovic J. Myorhythmia: Phenomenology, etiology, and treatment. Mov Disord 2014; 30:171-9. [DOI: 10.1002/mds.26093] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 10/28/2014] [Accepted: 11/01/2014] [Indexed: 11/08/2022] Open
Affiliation(s)
- José Fidel Baizabal-Carvallo
- Parkinson's Disease Center and Movement Disorders Clinic; Department of Neurology; Baylor College of Medicine; Houston Texas USA
| | - Francisco Cardoso
- Movement Disorders Clinic; Neurology Service; Department of Internal Medicine; The Federal University of Minas Gerais; Belo Horizonte MG Brazil
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic; Department of Neurology; Baylor College of Medicine; Houston Texas USA
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Smith KM, Deik A, Stern MB, Thompson P. Undulating Lingual Dyskinesia With Symptomatic Palatal Tremor and Inferior Olivary Hypertrophy Following Cerebellar Hemisphere Hematoma. Mov Disord Clin Pract 2014; 1:245-246. [DOI: 10.1002/mdc3.12045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 04/23/2014] [Accepted: 04/24/2014] [Indexed: 11/11/2022] Open
Affiliation(s)
- Kara M. Smith
- Parkinson's Disease and Movement Disorders Center; Department of Neurology; Perelman School of Medicine at the University of Pennsylvania; Philadelphia PA USA
| | - Andres Deik
- Parkinson's Disease and Movement Disorders Center; Department of Neurology; Perelman School of Medicine at the University of Pennsylvania; Philadelphia PA USA
| | - Matthew B. Stern
- Parkinson's Disease and Movement Disorders Center; Department of Neurology; Perelman School of Medicine at the University of Pennsylvania; Philadelphia PA USA
| | - Philip Thompson
- Department of Neurology; University of Adelaide and Royal Adelaide Hospital; Adelaide Australia
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6
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Mitsueda T, Nakaya Y, Hagiwara M, Manabe T, Matsui M. [Case of an elderly woman with dementia showing episodic involuntary movement of the tongue]. Rinsho Shinkeigaku 2014; 54:321-4. [PMID: 24807276 DOI: 10.5692/clinicalneurol.54.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report a 93-year-old woman with dementia who developed generalized convulsion and involuntary movement of her tongue. She could independently walk and eat meals until 8 months ago, however she turned into bedridden. When she was admitted to our emergency room due to status epilepticus, her tongue intermittently moved from the midline to the left. She could not eat or speak during this episodic tongue movement. MR imaging study revealed brain atrophy in the bilateral mesial temporal lobe, consistent with senile dementia of Alzheimer type. Despite her tongue movements seemingly developing to the generalized convulsion, EEG study did not indicate epileptiform discharges corresponding to this movement. Although antiepileptic drug therapy was effective, we needed polytherapy to control this movement. Paroxysmal tongue movements were previously reported in cases of epilepsy, brain tumor, and stroke, observed bilaterally in most cases. This episodic tongue movement would be rare in terms of the clear laterality. The etiology of this movement was presumed as focal seizure, palatal tremor, dyskinesia or others, but was undetermined. Episodic movements involving tongue decrease the quality of daily life especially in the elderly. Therefore, we should pay more attention to it and try to treat it earlier.
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Abstract
This chapter reviews focal dyskinesias that affect a restricted region of the body in isolation. Focal dyskinesias often affect body parts not commonly involved in isolation by movement disorders and are not readily classified into one of the major categories of movement disorders or peripheral nerve excitability syndromes. The clinical features and phenomenology of these "unusual focal dyskinesias" are discussed according to the region affected (ear, lip, chin, jaw, tongue, abdomen, and diaphragm (belly dancer's dyskinesias), back, scapula, and limbs). The phenomenology and origin of the unusual focal dyskinesias remain the subject of debate. Most are characterized by slow semirhythmic jerky movements at variable (usually slow) frequencies superimposed on sustained postures, consistent with dystonic movements. However, the body parts affected and pattern of occurrence (in repose rather than during action) are different to those usually seen in primary dystonia. Many of the unusual focal dyskinesias are associated with trauma and pain to the affected region, prompting the suggestion that the movements follow central sensorimotor reorganization occurring spontaneously or secondary to changes in the peripheral nervous system. In other cases, inconsistent signs and spontaneous recovery suggest a psychogenic origin.
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Affiliation(s)
- Annu Aggarwal
- Department of Neurology, Royal Adelaide Hospital and University Department of Medicine, University of Adelaide, Adelaide, Australia
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Li JY, Chen CC, Lee CH. Epileptic lingual myoclonus associated with cavernoma. Mov Disord 2009; 25:250-1. [DOI: 10.1002/mds.22892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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9
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Episodic dystonic spasm of the bilateral edge of the tongue during a coma following anoxic encephalopathy. J Clin Neurosci 2009; 16:1252-3. [DOI: 10.1016/j.jocn.2008.12.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Revised: 12/09/2008] [Accepted: 12/29/2008] [Indexed: 10/20/2022]
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10
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Li JY, Lee CH. Episodic tongue hyperkinesias and alternating limb movements associated with basilar artery ischemia. Mov Disord 2009; 24:1249-51. [DOI: 10.1002/mds.22542] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Mondria T, de Gier HHW, Boon AJW. New device to control combined lingual and palatal myoclonus. Mov Disord 2007; 22:573-6. [PMID: 17260342 DOI: 10.1002/mds.21320] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Lingual myoclonus is a poorly understood disorder that may occur in isolation or combined with palatal myoclonus. In this report, we present the case history of a 21-year-old patient with a therapy-resistant essential lingual and palatal myoclonus where a simple dental device was able to control symptoms. The use of this device will be highlighted and compared to previously described methods. Cases of previously recorded lingual and palatal myoclonus will be reviewed and compared to the case of our patient.
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Affiliation(s)
- Tjeerd Mondria
- Department of Neurology, Erasmus Medical Centre Rotterdam, The Netherlands.
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Saka E, Ozkaynak S, Tuncer R. Tongue tremor in brainstem pilocytic astrocytoma. J Clin Neurosci 2006; 13:503-6. [PMID: 16678738 DOI: 10.1016/j.jocn.2005.06.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2005] [Accepted: 06/23/2005] [Indexed: 10/24/2022]
Abstract
An isolated tremor of the tongue developed in a 22-year-old female patient in a minimally conscious state. The patient was diagnosed with brainstem pilocytic astrocytoma. A widespread lesion of the brainstem and cerebellum was evident on cranial magnetic resonance imaging. The pathophysiology of isolated tongue tremor is discussed with the magnetic resonance findings and the relevant literature.
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Affiliation(s)
- Esen Saka
- Department of Neurology, Akdeniz University Hospitals, Dumlupinar Bulvari, 07059 Antalya, Turkey.
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13
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Lee PH, Yeo SH. Isolated continuous rhythmic involuntary tongue movements following a pontine infarct. Parkinsonism Relat Disord 2005; 11:513-6. [PMID: 16256406 DOI: 10.1016/j.parkreldis.2005.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2005] [Revised: 07/04/2005] [Accepted: 07/04/2005] [Indexed: 11/27/2022]
Abstract
Isolated involuntary tongue movements are rare and poorly understood. The anatomical substrate and pathogenesis underlying involuntary tongue movements remain elusive. We describe a patient who developed isolated continuous rhythmic involuntary tongue movements after pontine infarct without evidence of hypertrophy of inferior olivary nucleus on follow-up magnetic resonance image. We discuss the rhythmic involuntary tongue movements as a prototype of involuntary hyperkinetic movement released by a central pacemaker.
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Affiliation(s)
- Phil Hyu Lee
- Department of Neurology, Ajou University College of Medicine, Woncheon-dong San 5, Paldal-Ku, Suwon 442-749, South Korea.
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14
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Chung SJ, Im JH, Lee JH, Cho AH, Kwon M, Lee MC. Isolated tongue tremor after gamma knife radiosurgery for acoustic schwannoma. Mov Disord 2004; 20:108-11. [PMID: 15390040 DOI: 10.1002/mds.20271] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We describe a patient who had an isolated tongue tremor with an audible click after gamma knife radiosurgery for acoustic schwannoma. The nature of the tongue tremor was clearly demonstrated by videofluoroscopy. The possible pathogenic mechanisms are discussed.
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Affiliation(s)
- Sun J Chung
- Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea
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Lin K, Lin J, Piovesan EJ, Germiniani FMB, Teive HAG, Werneck LC. Tongue tremor in a patient with coma after electrical injury. Mov Disord 2003; 18:834-6. [PMID: 12815667 DOI: 10.1002/mds.10433] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
We report on the case of a patient with transient tongue tremor and coma after electrical injury, probably due to a reversible brainstem dysfunction. We then reviewed the differential diagnosis of abnormal involuntary movements of the tongue as well as movement disorders related to electrocution.
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Affiliation(s)
- Katia Lin
- Movement Disorders Unit, Neurology Service, Department of Internal Medicine, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
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