Isolated continuous rhythmic involuntary tongue movements following a pontine infarct

Lingual Hyperkinesia as An Initial Manifestation of Wernicke’s Encephalopathy: Evidence for Localization of Involuntary Hyperkinetic Movement of the Tongue

“…Several underlying conditions associated with isolated involuntary or abnormal tongue movements have been reported, including thalamic or pontine infarction, brainstem ischemia, radiosurgery for acoustic schwannoma, electrical injury, Arnol-Chiari malformation, Miller-Fisher syndrome, Bickerstaff 's encephalitis, amyotrophic lateral sclerosis, drug-induced or drug-intoxication, chronic epilepsy and multiple sclerosis [7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Among the above these reports, only some reports revealed the neuro-radiological localization of the involuntary hyperkinetic movements of the tongue (Table 1) [7,8,10,11,13,20]. The slower frequency and some of the phenomenological characteristics of the involuntary tongue movements observed in our case might be similar to the features of oculofacial or oculomasticatory myorhythmia, which is characterized by relatively rhythmic muscle contractions in ocular, facial, mastificatory, limb, and other muscles and is typically seen in brainstem or cerebellar disease and Whipple disease.…”

“…The brainstem, with involvement of the central tegmental tract at the pontine level or with of hypoglossal nuclei at the medullar level, was suspected to be the origin of the involuntary tongue movement [8,9,20]. WE possibly affect the brainstem, particularly the central Video segment 1: The patient showed irregular involuntary myorhythmic hyperkinesia and motor impersistance of the tongue in speaking serial Korean numbers from one to ten as well as protruding of the tongue.…”

Undulating tongue in Wilson′s disease

“…One can take a clue from other conditions wherein abnormal fasciculation, tremor, myoclonus, dyskinesias, undulating hyperkinesias and dystonia of the tongue have been described such as brainstem ischemia, head injury and chronic epilepsy. [4] It has been hypothesized that involvement of the pontine central tegmental tracts may play a role in the genesis of episodic lingual dyskinesias in patients with brainstem ischemia. [4] In patients with anti-N-methyl-D-aspartate receptor encephalitis, interruption of forebrain cortico-striatal inputs has been thought to remove the tonic inhibition of brainstem pattern generators releasing primitive patterns of bulbar and limb movement resulting in semirhythmic repetitive bulbar and limb movements.…”

“…[4] It has been hypothesized that involvement of the pontine central tegmental tracts may play a role in the genesis of episodic lingual dyskinesias in patients with brainstem ischemia. [4] In patients with anti-N-methyl-D-aspartate receptor encephalitis, interruption of forebrain cortico-striatal inputs has been thought to remove the tonic inhibition of brainstem pattern generators releasing primitive patterns of bulbar and limb movement resulting in semirhythmic repetitive bulbar and limb movements. [4] Acute severe hemilingual dyskinesias have also been described in non-Wilson's, non-Menkes disorders of copper metabolism, in the presence of normal brain and spinal MRI, wherein it has been posited that abnormal copper deposition per se might cause abnormal lingual movements by yet unknown mechanism.…”

Involuntary Craniofacial Lingual Movements in Intensive Care-Acquired Quadriplegia

“…Certainly an argument can be made for movement disorders originating from the pons as this has been well reported in the recent literature [2][3][4][5][6][7]. Bauer et al in 1980 [5] initially described involuntary motor phenomenon seen in patients with locked-in-syndrome.…”