Serpentine tongue

Abstract

A 69-year-old man presented with parkinsonism (asymmetric pill-rolling tremor, bradykinesia, and rigidity) and a distinctive serpentine tongue dyskinesia (video). The movement was constantly present at rest, stopping only when speaking, swallowing, or sleeping. There had been no known exposure to neuroleptic medication. The lingual dyskinesia was noted before levodopa was introduced as a treatment for presumed Parkinson disease. However, beneficial response to levodopa was poor and led to worsening of the dyskinesia. The patient subsequently developed fecal and urinary incontinence as well as symptomatic orthostatic hypotension.Multiple system atrophy is most likely, with an associated orofacial dyskinesia exaggerated by levodopa.

Parkinson's disease relevant pathological features are manifested in male Pink1/Parkin deficient rats

“…Tremor is one of the most visible features of PD, and the typical PD tremor occurs at rest and usually begins in a limb, often in hands or fingers ( Heusinkveld et al, 2018 ). Further, the dKO rats exhibit abnormal movements of the mouth and tongue ( Supplementary Video 4 ) reminiscent of lingual dyskinesia or lingual protrusion dystonia, which are described in PD patients ( Maiola et al, 2016 ; Sheehy et al, 2008 ). While rats can't vomit, they can regurgitate, and the dKO rats appear to occasionally undergo retching movements ( Supplementary Video 4 ), suggesting they may be experiencing gastroparesis, another symptom in PD.…”

Galloping tongue syndrome in a PRRT2 mutation carrier

“…Galloping tongue is an uncommon movement disorder. 1–5 The characteristics of these lingual movements have been variably described as transverse contractions, twisting, or undulating movements. 2–5 Although these movements were present with the tongue at rest in most of the reported patients, in some cases the movements were also observed during sustained action.…”

Clinical Neurology in Practice

“…Repetitive protrusion and retraction of the tongue was described as ‘trombone tongue’ (also called ‘fly-catcher tongue’ or sometimes wrongly ‘serpentine tongue’), as first observed in neurosyphilis and also observed in medullar compression 85 . First described in an untreated patient with multiple system atrophy, 86 the real ‘serpentine tongue’ (‘jack in a box tongue’) corresponds to incessant writhing movements of the tongue at rest (stopping only when speaking, swallowing, or sleeping); this phenomenon may be part of Parkinsonian tardive dyskinesia due to levodopa therapy, 87 but was also observed with other treatments (risperidone, metoclopramide) 88,89 . The ‘candy sign’ (or ‘bonbon sign’), first described by Camillo Negro in 1913 in a patient with neurosyphilis (considered as pathognomonic of this disease), is the repetitive sporadic poking of the tongue into the cheek, causing an outpouching 90 …”