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April 12, 2022; 98 (15) Resident & Fellow Section

Teaching Video NeuroImage: Tongue Tremor as a Presenting Feature of Progressive Supranuclear Palsy

Mamoun Saeed, Gregory Scott, Stephen Murphy
First published February 10, 2022, DOI: https://doi.org/10.1212/WNL.0000000000200147
Mamoun Saeed
From the Charing Cross Hospital (M.S., G.S., S.M.), Imperial College Healthcare NHS Trust; and Chelsea and Westminster Hospital (M.S., G.S., S.M.), Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
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Gregory Scott
From the Charing Cross Hospital (M.S., G.S., S.M.), Imperial College Healthcare NHS Trust; and Chelsea and Westminster Hospital (M.S., G.S., S.M.), Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
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Stephen Murphy
From the Charing Cross Hospital (M.S., G.S., S.M.), Imperial College Healthcare NHS Trust; and Chelsea and Westminster Hospital (M.S., G.S., S.M.), Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
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Teaching Video NeuroImage: Tongue Tremor as a Presenting Feature of Progressive Supranuclear Palsy
Mamoun Saeed, Gregory Scott, Stephen Murphy
Neurology Apr 2022, 98 (15) 642; DOI: 10.1212/WNL.0000000000200147

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A 76-year-old man was referred to neurology by speech and language therapy after video fluoroscopy showed oropharyngeal dysphagia, aspiration, and tongue tremor (Video 1). He had presented with 6 months of progressive dysphagia, dysarthria, weight loss, and falls. Examination revealed akinetic rigidity, vertical supranuclear gaze palsy, slowed saccades, dysarthrophonia, and tongue tremor without palatal, jaw, or limb tremor. We diagnosed probable progressive supranuclear palsy (PSP). He did not respond to levodopa (400 mg/d). On a follow-up assessment 27 months later, the tremor persisted (Video 1). Tremor, usually upper limb, occurs in 42% of PSP cases.1 Isolated tongue tremor is a rare feature of PSP.1,2

Video 1

Tongue tremor as a presenting feature of progressive supranuclear palsy (PSP). A sagittal video fluoroscopy (June 2019) demonstrating a tongue tremor alongside moderate-to-severe oral and pharyngeal dysphagia and silent aspiration. On review in October 2021 after a fall, the continuous tongue tremor was still evident, without palatal or jaw tremor.Download Supplementary Video 1 via http://dx.doi.org/10.1212/200147_Video_1

Study Funding

The authors report no targeted funding.

Disclosure

All authors report no disclosures. Go to Neurology.org/N for full disclosures.

Acknowledgment

We thank the patient for consenting to be featured in this report.

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Footnotes

  • Go to Neurology.org/N for full disclosures.

  • Teaching slides links.lww.com/WNL/B810

  • © 2022 American Academy of Neurology

References

  1. 1.↵
    1. Fujioka S,
    2. Algom AA,
    3. Murray ME, et al
    . Tremor in progressive supranuclear palsy. Parkinsonism Relat Disord. 2016;27:93-97.
    OpenUrlPubMed
  2. 2.↵
    1. Shoeibi A,
    2. Litvan I
    . Prominent tongue and jaw tremor in a patient with probable progressive supranuclear palsy. Movement Disord Clin Pract. 2018;5(1):99-100.
    OpenUrl

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