Objective: To present an unusual case of transient, isolated tongue tremor from an ischemic stroke.

Background: Isolated tongue tremor is an uncommon neurological symptom. A few cases have been reported in association with brainstem astrocytoma, post-radiosurgery, electrical injury, liver cirrhosis, Wilson’s disease and drug use. It can also be a rare initial presentation of essential tremor and Parkinson’s disease. However, isolated tongue tremor has to our knowledge not yet been reported as a manifestation of acute stroke.

Methods: Case report.

Results: An 82-year-old right-handed Caucasian male with past medical history of recurrent strokes, diabetes, hypertension, atrial fibrillation and chronic kidney disease who presented to the ER with difficulty speaking and abnormal tongue movement after waking up. On neurological examination, tongue tremor was observed both at rest and upon protrusion, without weakness of tongue muscles, tongue deviation or atrophy. No tremor or other hyperkinetic movements of palate, mandible, or other parts of the body were seen. Except for mild dysarthria, the remainder of the neurological exam was normal. MRI brain showed evidence of acute ischemic stroke involving the left frontoparietal region which includes the area representing the motor function of the tongue on the cortical homunculus. No imaging abnormalities were detected in the brainstem, cerebellum, or basal ganglia. In this patient, the tremor had a sudden onset and the patient had many risk factors for stroke. Additionally, there was no recent initiation or adjustment of medication. None of his current medication has been reported to cause tremor. Therefore, an acute stroke would contribute to isolated tongue tremor in this patient. The tremor gradually improved over a few days without any additional treatments. Difficulty speaking resolved. The patient had no swallowing problem. He was discharged after 2 days of hospitalization. At 3 weeks, the tremor was almost completely resolved. We review cases of tongue tremor in the literature. Videos will be demonstrated.

Conclusions: This report provides evidence that isolated tongue tremor can develop after unilateral cortical lesion, especially from acute infarction. Since the cortical origin of symptomatic palatal tremor (SPT) has been described, this patient, presenting with isolated tongue tremor but without palatal tremor might constitute an abortive form of SPT. The previous version was presented at the 141st annual meeting of American Neurological Association during October 16-18, 2016.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/symptomatic-isolated-tongue-tremor-of-cortical-origin-due-to-stroke/