Myosonography: An Easy and Painless Technique to Detect Tongue Fasciculations

摘要

A58-year-old womanwas diagnosed withmotor neuron disease(ALS) of 8-month duration. Examination showed spastic dysarthria,atrophictongue, diffusefibrillations, mild wasting,and weakness ofintrinsic muscles of hands, brisk tendon jerks,and bilateralflexor plantar response.Nerveconduction studywas normal. Needleelectromyography (EMG) oftongueshowed diffusefibrillations (40–50 Hz)and no fasciculation[Video 1]. High-resolution ultrasonography (HRUS) ofthetongue was done with 12–3 MHzlinear transduceras shown in Figure 1a. The Bmodescanshowed fasciculationsappearing as involuntary twitching ofsmall parts ofresting genioglossus [Video 2] within 30 s. The M-modescanshowed irregular verticalcrackscorresponding to each fasciculation [Figure 1b]. HRUS also revealed fasciculations in bilateral deltoid, biceps,triceps,and brachioradialis whichwereabsent onEMG.