Category: Tremor
Objective: To describe lingual tremor as a neurological manifestation associated with a cortical ischemic lesion.
Background: Lingual tremor is a rare movement disorder that has occasionally been described secondary to cortical cerebral infarctions. We present a patient diagnosed with ischemic stroke of the left middle cerebral artery (LMCA) and left M1 stenosis who developed lingual tremor.
Method: A 69-year-old man with a history of atrial flutter and a ischemic LMCA stroke with residual aphasia one month prior to consultation. He presented worsening aphasia, right arm paresia, and facial movements. Neurological examination revealed global aphasia, mild right upper limb paresis, and rhythmic tongue movements (video 1), compatible with lingual tremor. No palatal tremor was observed.
Results: Computed tomography showed a subacute infarction in the LMCA territory, with critical stenosis of the left M1 segment and a left frontal penumbra area. The patient was not a candidate for revascularization therapy due to an established infarction and absence of large-vessel occlusion. Electroencephalography did not show epileptiform activity. Brain magnetic resonance imaging revealed subacute left frontoparietal subcortical infarctions without abnormalities of the triangle of Mollaret (image 1). Treatment with clonazepam 1 mg daily improved the tremor until it resolved within 48 hours, with sustained response after discontinuation.
Conclusion: This would be the third reported case of lingual tremor secondary to cortical infarction to date and the first associated with vascular stenosis. The tremor resolved after treatment with benzodiazepines. The underlying mechanism in this case may be related to dysfunction of cortico-subcortical networks and to “limb-shaking–like” phenomena. In cases of acute lingual tremor associated with other neurological focal deficits, a cortical lesion should be investigated.
References: 1. Neurology® 2020;94:591-592. doi:10.1212/WNL.0000000000009174
2. Mov Disord Clin Pract 2015 Dec 18;3(2):214-215. doi: 10.1002/mdc3.12288. eCollection 2016 Mar-Apr.
To cite this abstract in AMA style:
A. Bonilla Tena, S. Secades, A. Contreras Chicote, B. Casa Fages, E. Luque Buzo, J. Pérez Sánchez, V. Pérez Olmo, A. Iglesias Mohedano, S. Gomez, F. Grandas Pérez. Lingual tremor secondary to ischemic stroke of the left middle cerebral artery. Another movement disorder with cortical localization? [abstract]. Mov Disord. 2026; 41 (suppl 1). https://www.mdsabstracts.org/abstract/lingual-tremor-secondary-to-ischemic-stroke-of-the-left-middle-cerebral-artery-another-movement-disorder-with-cortical-localization-2/. Accessed October 1, 2026.« Back to 2026 International Congress
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-2/