tongue deviation differential diagnosis

Tongue deviation in unilateral stroke most likely results from asymmetrical supranuclear control of the 12th cranial nerve in many individuals. Diagnostic evaluation may include measuring the degree of head tilt and face turn. Any lesion that cannot be easily or accurately diagnosed should be referred to a specialist for further evaluation. This diagnosis must account for the most unusual feature of this case, the deviation of the tongue to the left. Your healthcare provider will examine your symptoms before making a diagnosis and offering treatment. Have you experienced any major changes in your life? [ 21, 22, 23] Occasionally, plaquelike lesions of lichen planus and lupus erythematosus may resemble areas of frictional keratosis. and transmitted securely. The hypoglossal nerve can be damaged at the hypoglossal nucleus, above the hypoglossal nucleus (supranuclear), or interrupted at the motor axons (infranuclear). 2015 Jul;53(1):95-6. doi: 10.1016/j.pediatrneurol.2015.03.009. If the treatment is not successful, your healthcare provider may offer another diagnosis based on how your symptoms relate to another condition. A structure for accurate diagnosis is proposed beginning with a very careful history. With the help of additional testing, the likelihood of error after following the diagnostic process significantly reduces. PMC Persistent idiopathic unilateral hypoglossal [corrected] nerve palsy: a case report. Additional symptoms that M.J. has that are consistent with this diagnosis are peptic ulcer disease, increase in menstrual bleeding, and low iron levels. He described the condition as a wandering rash of the tongue. The most commonly affected site is the anterior two-thirds of the dorsal tongue, although these benign red and white lesions can also present on other oral mucosal sites.4,5 Geographic tongue has a number of monikers, including lingua geographica, erythema migrans, exfoliation areata lingua, superficial migratory glossitis, lingual dystrophy, pityriases linguae, transitory benign plaques of the tongue, marginal exfoliative glossitis, ectopic geographic tongue and glossitis areata migrans. FOIA Other causes of RAU include drug reactions, Marshall Syndrome, and MAGIC (Mouth and Genital ulcers with Inflamed Cartilage) syndrome. It is necessary in many functions, including the synthesis of both DNA, RNA and myelin production, particularly in the spinal cord. DeJong's the neurologic examination, 7th ed. 2,3 The differential diagnosis for masses of the tongue base includes normal lymphatic tissue, ectopic thyroid tissue, lymphoma, lipoma, hemangioma, schwannoma, granular cell tumors, benign and malignant tumors of minor salivary gland origin, rhabdomyosarcoma, and metastatic disease. The hyperacute clinical diagnosis of stroke remains a major challenge, as 1 in 4 suspected cases turns out to be a stroke mimic. Familiarity with common characteristics of oral lesions in regard to color, shape, size, location and morphology assists practitioners in making an accurate diagnosis. Commonly used topical antifungal agents, such as nystatin or clotrimazole, as well as systemic medications, have demonstrated efficacy in resolving these lesions.9 Other conditions, such as irritation fibroma, granular cell tumor and tertiary syphilis, may be considered in the differential diagnosis.16. MeSH Pink-red on dorsal and ventral surfaces. Stein SL, Mancini AJ. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://www.cmpa-acpm.ca/en/education-events/good-practices/physician-patient/clinical-decision-making), (https://www.cdc.gov/urdo/differential.html). Clinical presentation of hairy tongue is classic, and, as such, biopsies are generally unnecessary.5 As a benign condition, treatment is usually not required, although gentle debridement of the tongue with a soft toothbrush or commercial tongue scraper can expedite the removal of the keratin. It's important to stay in contact with your healthcare provider during your diagnostic process especially if you have any changes to your symptoms or medical history, which could affect the results of your diagnosis. The concept of trauma includes surgical trauma as with carotid endarterectomy (surgery to remove the plaques from the carotid artery). Hypoglossal Nerve in Neurologic Disorders: Progressive bulbar palsy and advanced MND can cause severe tongue atrophy and an inability for the tongue to be protruded leading to the inertia of the tongue. Glossitis, by causing swelling of the tongue, may also cause the tongue to appear smooth. This list is not your final diagnosis, but a theory as to what is potentially causing your symptoms. Microglossia may result from pseudobulbar palsy, damage to the upper motor neurons of the corticobulbar tracts that innervate the tongue. (5) This should not be confused with a medial medullary lesion. Costa FW, Osterne RL, Mota MR, Alves AP, Soares EC, Sousa FB. The majority of our taste buds are in these papillae. The commonest acute causes of pain are dental and these are well managed by dentists. 2023 Feb 15;439:114252. doi: 10.1016/j.bbr.2022.114252. A bright pink color on the tongue is most often due to a deficiency in iron, folic acid, or vitamin B-12. A differential diagnosis of abdominal pain includes: Symptoms of asthma include shortness of breath, wheezing, pain or a tight feeling in your chest and coughing. TMD is classified as intra-articular or extra-articular. Usually, one side of the tongue is affected, and when the person sticks out his or her tongue, it deviates or points toward the side that is damaged. When one of the two nerves is damaged, then the tongue, when protruded will deviate towards the damaged nerve because of the overaction of the strong genioglossus muscles. Another clinical variant is plaque-like oral lichen planus, which presents with white elevated patches (Figure 7). She can be reached at: [emailprotected], Considerations for Pediatric Local Anesthesia, Diagnosing and Treating Nasopalatine Duct Cysts, Porphyromonas gingivalis Role In the Pathogenesis of Periodontal Disease, Broadening Clinical Perspectives on Inferior Alveolar Nerve Blocks. Gonsalves WC, Chi AC, Neville BW. Can you diagnose the cause of the patients lymphedema? 3(1):37. Several predisposing factors have been implicated in its pathogenesis, including smoking and poor oral hygiene.12,14 A number of medications, such as antibiotics, antihypertensives, corticosteroids, psychotropics, and oxidizing agents such as hydrogen peroxide, are thought to contribute to the development of hairy tongue primarily because they cause xerostomia symptoms. Hypoglossal nerve or tongue muscle involvement may manifest as ipsilateral tongue deviation. Patient history and risk factors are important to note. During a differential diagnosis, it might be daunting to see a list of possible conditions that could cause your symptoms. J Speech Lang Hear Res. Oral candidiasis, or thrush, is the result of infection of the oropharynx byCandida albicans. Fujii H, Ohtsuki T, Takeda I, et al. Other terminology has been ascribed to this condition, such as lingua villosa nigra, hyperkeratosis of the tongue, nigrities linguae, keratomyositis linguae and melanotrichia linguae but none of these is commonly used today.12, Hairy tongue affects the filiform papillae, which undergo hypertrophy and therefore elongate. Dermatology. A biopsy may be needed to confirm the clinical diagnosis when the clinical presentation is not readily apparent. Disclaimer. The patient does each movement twice: once slowly and the next rapidly. Your healthcare providers goal is to treat the correct condition and not endanger you. Testing strength consists of the patient forcing the tongue to the side against the patients cheek, while the examiner tries to dislodge the tongue using his/her finger[2]. Neville BW, Damm DD, Allen CM and Bouquot JE. government site. Nutritional deficiencies include iron, folate and vitamin B12 deficiency. The current term of approval extends from 7/1/2021-6/30/2023. Promoting the Culture of Bedside Medicine, Promoting Inclusive Care at the Patient Bedside, Through a Patients Eyes: Physicians Reflect on Personal Illness, Physical Exams and Clinical Observations Related to Cardiovascular Health, Combat Physician Burnout with the Joy of Bedside Medicine, Physical Exam Techniques to Support and Promote Womens Health, How Physicians Go Above and Beyond to Promote Patient Healing, How to Address Monumental Patient Conversations, The Importance of Cultural Competence in Bedside Medicine, How Physicians Can Help Promote Early Detection of Prostate Cancer, 7th Time's a Charm: The 2022 Stanford 25 Skills Symposium, Communication Strategies to Help Physicians Lead Meaningful Patient Conversations, Bringing Tidings of Comfort and Joy to the Patient Bedside, Registration is Now Open for the 2021 Stanford Medicine 25 Skills Symposium, Medscape Article Highlights Need for Physical Exam Training & Assessment, The Resurgence of Bedside Teaching During the Pandemic, The Presence 5 for Racial Justice: Promoting Anti-Racism in Clinical Interactions, Dr. Vergheses Rules for the Bedside Exam, Bringing Human Connection to the Forefront of Medicine in a Technological Era, Five Practices to Strengthen the Physician-Patient Relationship, Telehealth Tips to Preserve Key Aspects of Patient Care, How AI Can Improve the EHR and Bedside Medicine, Bedside Teaching is a Powerful Learning Tool in the ICU, Thoughtful Implementation of Machine Learning Can Help Physicians Improve Patient Care, Register Now for the 5th Annual Stanford 25 Skills Symposium, Cultivating The Golden Minute at the Bedside, Four Physicians Describe the Synergy Between Technology and Bedside Medicine, Artificial Intelligence and the Gift of Physician Time, Compassion: A Powerful Tool for Improving Patient Outcomes, The Physical Exam Remains an Effective Tool for Physicians, Learning from the Bedside at the 5th Annual Stanford 25 Bedside Teaching Symposium, Physicians Can Protect the Human Connection in Medicine, A Diagnosis of Nelson's Syndrome and Why You Won't See it Anymore. Using Google Glass to Examine the Hand with Dr. Verghese. 1 0 obj <> endobj 2 0 obj <> endobj 4 0 obj <>/Type /Page>> endobj 7 0 obj <> stream 2000 Aug. 29(7):331-5. xw`E?<3{no/\KBr$$AjHRTD, `,(E,E%B; Commonly referred to as benign migratory glossitis, geographic tongue was first identified by French physician Pierre Franois Olive Rayer in 1831. tongue weakness Differential Diagnosis Lambert-Eaton Syndrome Botulism Intracranial mass Drug-induced myasthenia gravis Thyroid disorders Stroke Congenital [emdocs.net] Dermatol Clin. The other differential diagnosis is subarachoid haemorrhage. You may have a sore, tender, or swollen tongue. It may seem overwhelming to see a list of possible conditions that might affect you, but remember that your differential diagnosis is not the final diagnosis. The tongue exam can reflect a number of underlying diagnoses such as infections, nutritional deficiencies, malignancy and even neurological dysfunction. 2009 Feb;29(1):45-52. doi: 10.1055/s-0028-1124022.

Cold Waters Weapons Guide, Reserve Police Officer Louisiana, Articles T