Objective: Lingual tremor is an uncommon movement disorder, occasionally reported secondary to cortical strokes. We present a patient diagnosed with an ischemic stroke of the left middle cerebral artery (LMCA) and left M1 stenosis, who developed lingual tremor.

Background: A 69-year-old male with a history of atrial flutter and ischemic stroke of the LMCA presented one month later with worsening aphasia, right arm clumsiness, and facial movements. Neurological examination revealed global aphasia, mild right upper limb paresis, and pseudorhythmic tongue movements compatible with lingual tremor. Palatal tremor was absent.

Method: A 69-year-old male with a history of atrial flutter and ischemic stroke of the LMCA presented one month later with worsening aphasia, right arm clumsiness, and facial movements. Neurological examination revealed global aphasia, mild right upper limb paresis, and pseudorhythmic tongue movements compatible with lingual tremor. Palatal tremor was absent.

Results: Computed tomography showed a subacute infarction in the LMCA territory, with critical left M1 stenosis and a left frontal penumbra area. The patient was not a candidate for revascularization due to an established infarction and the absence of large vessel occlusion. Electroencephalography did not reveal epileptiform activity. Brain MRI confirmed subacute fronto-parietal subcortical infarctions without abnormalities in Mollaret’s triangle. Treatment with clonazepam (0.5 mg every 12 hours) resulted in significant tremor improvement

Conclusion: This is the third reported case of lingual tremor secondary to cortical infarction and the first associated with vascular stenosis. The underlying mechanism may involve dysfunction of cortico-subcortical networks and limb-shaking phenomena. Benzodiazepine treatment proved effective. We propose that in cases of acute lingual tremor with concurrent focal neurological signs, a cortical lesion should be investigated.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/lingual-tremor-secondary-to-ischemic-stroke-of-the-left-middle-cerebral-artery-another-movement-disorder-with-cortical-localization/