Tongue tremor: An unusual presentation of Parkinson disease

A 56-year-old woman presented with complaints of decreased sleep, low mood but no history of tremor. A complete history and clinical examination were done, which revealed bradykinesia, mask-like face and significant tongue tremor (video available at www.nmji.in) in the resting state. Her relevant investigations and magnetic resonance imaging of the brain were normal. We started levodopa plus carbidopa for her problems and there was improvement in her sleep, mood, tongue tremors and bradykinesia.

Figure 1: Tongue tremor in Parkinson disease (video available at www.nmji.in)

Parkinson disease typically presents as unilateral tremor in the upper extremities, rigidity and bradykinesia. Of these, resting tremors are most characteristic of Parkinson disease.^[1] The re-emergent characteristic of the Parkinson disease tremor is a key feature which helps to differentiate it from essential tremor.^[2]

Tongue tremor may be an early sign of Parkinson disease. This observation illustrates that Parkinson disease rest tremor can affect various body parts, going from the classical asymmetrical hand or foot tremors to a much less common presentation such as head tremors.^[3]

Conflicts of interest. None declared