1. Hemigeographic tongue following an acute ischemic stroke
Teaching NeuroImages
Neurology
Resident and Fellow Section
© 2015 American Academy of Neurology

2. Vignette
We present two patients with a hemigeographic tongue following an acute ischemic stroke.
A 70-year-old male was admitted due to a left MCA stroke (Fig 1 A and B) with global aphasia and a right hemiparesis.
A 43-year-old male was admitted due to a subcortical left ischemic stroke (Fig 2 A and B) with dysarthria and a right hemiparesis.
Delgado et al
© 2015 American Academy of Neurology

3. Imaging
Figure 1. A. Hemigeographic tongue in a 70-year-old patient (white arrow). B. Brain CT showed an ischemic stroke in the middle cerebral artery territory (white arrow).
Delgado et al
© 2015 American Academy of Neurology

4. Imaging
Figure 2. A. Hemigeographic tongue in a 43-year-old male (white arrow). B. Cranial MRI (FLAIR T2 sequences) showed a lenticular ischemic stroke (white arrow).
Delgado et al
© 2015 American Academy of Neurology

5. Hemigeographic tongue following an acute ischemic stroke
Trigeminal trophic syndrome (TTS) is an unusual complication of trigeminal injury that causes a neuropathic disorder which characteristically involves ulceration of the nasal ala, and less frequently, the ipsilateral cheek, upper lip, and forehead.
Several causes of TTS have been described, amongst which are trigeminal nerve section or infarction of the brainstem.
The presence of a not previously described, contralateral hemigeographic tongue following a hemispheric acute stroke, points toward a central trigeminal disturbance, probably related with a cortical connection lesion.
This would suggest a complex mechanism in the occurrence of the TTS in which supranuclear lesions should also be included.
1. Pichard DC, Cowen EW. Trigeminal trophic syndrome after stroke. Mayo Clin Proc Sep;89:e87-8.
2. Curtis AR, Oaklander AL, Johnson A, Yosipovitch G. Trigeminal trophic syndrome from stroke: an under-recognized central neuropathic itch syndrome. Am J Clin Dermatol Apr 1;13:125-8.
© 2015 American Academy of Neurology