Differential diagnosis of tongue fasciculations

Continuum p21 2009

1. Lower motor neuron disease (ALS, Kennedy disease, SMA, poliomyelitis
2. Muscle specific receptor tyrosine kinase, MG
3. Brainstem lesion
4. Base of skull tumor
5. Radiation in area of skull base
6. Unilateral hypoglossal neuropathy
7. organophosphates

Pearl tongue weakness is as useful as tongue fasciculations. Test by asking patient to move tongue against cheek on each side and hold against resistance. If the disease is UMN only, this may be only sign seen on tongue. Advanced ALS patients may be unable to move their tongues at all.