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
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Acknowledgment
We thank the patient for consenting to be featured in this report.
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Footnotes
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Teaching slides links.lww.com/WNL/B810
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