Scenario 1. Common tongue conditions in primary care. Destruction of Vowel Space Area in Patients with Dysphagia after Stroke. Were conduct, Last chance! Oral lichen planus affects the buccal mucosa, tongue and gingiva most frequently; in fact, nearly half of all oral lichen planus lesions (44%) affect the tongue.19 The lesions usually present in a bilateral and often symmetrical pattern. https://thegeneralinfo.com/hypoglossal-nerve/, https://www.statpearls.com/articlelibrary/viewarticle/23265/, https://www.youtube.com/watch?v=e6X8vMYTSHs. FOIA Stein SL, Mancini AJ. Read More. E, Thyroglossal duct cyst with sinus tract, midline neck. 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. 209(2):88-94. Your physician or dentist can usually make a diagnosis of geographic tongue based on an examination of your tongue and your signs and symptoms. 2009 Feb;29(1):45-52. doi: 10.1055/s-0028-1124022. Bethesda, MD 20894, Web Policies By forming a differential diagnosis, additional testing is necessary to lead your healthcare provider to the correct diagnosis instead of treating symptoms without understanding the cause. Manually pulling up the weak side of the face eliminates the deviation. It may help to gauge tongue position in relation to the tip of the nose or the notch between the upper incisor teeth. Robert D Kelsch, DMD Associate Professor, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Oral Pathology Division, Department of Dental Medicine, Long Island Jewish Medical Center A person, particularly if it's a new patient, walk into the clinic treatment . Federal government websites often end in .gov or .mil. If you log out, you will be required to enter your username and password the next time you visit. Damage to the hypoglossal nerve causes paralysis of the tongue. Your healthcare provider will compile a differential diagnosis, which is a list of conditions that share the same symptoms to help make a final diagnosis. Supranuclear lesions cause weakness but no atrophy, and the weakness is rarely severe. The malignant transformation of oral lichen planus and oral lichenoid lesions: a systematic review. All tongue deviations were associated with supranuclear 7th nerve palsy. Should fit comfortably in mouth, tip against lower incisors. At times, candida species can coexist with oral lichen planus. There should be no hairs, furrows, or ulceration. Disclaimer. Huang YS, Wu HK, Chang HH, Lee TC, Huang SY, Chiang JY, Hsu PC, Lo LC. MeSH 1976 Nov. 42(5):591-6. Such damage causes eg. There may be a history of leukoplakia, dysphagia, or dysarthria. 2014 Nov. 98 (6):1281-98. The etiology of TMD is multifactorial and includes. Geographic tongue: clinical characteristics of 188 cases. Attention Dental Professionals! Campbell WW. It should not deviate to either side. Expand 3 PDF Save Alert Diagnosis and successful treatment of a caudal lingual abscess in a geriatric dog. Fitzpatrick SG, Hirsch SA, Gordon SC. Accessibility Fast Five Quiz: What Do You Know About Dental Health? To protrude the tongue in the midline, a balanced action of both genioglossus muscles is required. tongue deviation to the right, with no ophthalmoplegia. 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. Redman RS. Food is positioned on the body of the tongue and raised upward to the palate to break up the food prior to swallowing. In patients with insulin-dependent diabetes, median rhomboid glossitis is one of the most commonly reported presentations of oral candidiasis.17, Clinically, median rhomboid glossitis is identified by a zone of depapillation of the filiform papillae, which manifests along the midline of the posterior dorsal surface of the tongue, anterior to the circumvallate papilla (Figure 4). The location of the nerves to the tongue in and around the brain is near other nerves, so that if the nerve to the tongue (called . However, if there are associated symptoms such as difficulty with talking or swallowing, then a pathology should be ruled out. Tongue Shape An official website of the United States government. Transverse furrows across the tongue may be from a benign condition called scrotal tongue. Symptoms of abdominal pain include an ache, cramps or sharp pains at mild to severe levels localized to a specific area in your stomach region. The Hypoglossal nerve is the 12th cranial nerves that originate from the medulla obligate of the brain stem. 3. The https:// ensures that you are connecting to the You can easily see it if you look under your tongue in a mirror. Darwazeh AM, Almelaih AA. The tongue is first observed for position and appearance while it is at rest. Additional symptoms that M.J. has that are consistent with this diagnosis are peptic ulcer disease, increase in menstrual bleeding, and low iron levels. Recurrent aphthous ulceration or stomatitis (RAU/RAS) occurs in some systemic illnesses. The following symptoms and differential diagnoses are examples of what your healthcare provider might consider before making a final diagnosis. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Can you guess the cause of the patients bleed? Avcu N, Kanli A. J Tradit Complement Med. Additional materials were drawn from resources provided by Alejandro Stern, Stern Foundation, Buenos Aires, Argentina; Kathleen Digre, M.D., University of Utah; and Daniel Jacobson, M.D., Marshfield Clinic, Wisconsin. Tongue deviation in unilateral stroke most likely results from asymmetrical supranuclear control of the 12th cranial nerve in many individuals. Abraham Verghese Asks: Why Are We Doing This Teaching? FOIA American Academy of Oral and Maxillofacial Pathology. Bookshelf Careers. To alleviate anxiety, patients often need to be assured that it is a benign process.6 Treating geographic tongue with topical corticosteroids, topical anesthetic agents and antihistamines may help alleviate symptoms, but no specific therapy has demonstrated consistent success.5,6, The differential diagnosis for geographic tongue includes erythroplakia or candidiasis. Another clinical variant is plaque-like oral lichen planus, which presents with white elevated patches (Figure 7). This diagnosis must account for the most unusual feature of this case, the deviation of the tongue to the left. Last reviewed by a Cleveland Clinic medical professional on 01/27/2022. Dysphagia and dysarthria occurred in 43 and 90% of patients with tongue deviation. Progressive nuclear lesions, such as motor neuron disease, often cause fasciculations in addition to weakness. 2,3 Considering the safety of thrombolysis in stroke mimics (complication rate: 1.5%) 3 and its potential benefit in acute . 00001). The prevalence of oral mucosal lesions in a population in Ljubljana, Slovenia. One of the first signs of tongue cancer is a lump or sore on the side of your tongue that doesn't go away. Lower. A patient's tongue is usually what practitioners look at when they do the diagnosis. Assimakopoulos D, Patrikakos G, Fotika C, Elisaf M. Benign migratory glossitis or geographic tongue: an enigmatic oral lesion. xw`E?<3{no/\KBr$$AjHRTD, `,(E,E%B; To confirm your diagnosis, your provider might offer additional tests to confirm your diagnosis. Treatment includes any of a number of antifungals, including a nystatin gargle. [1] Normal tongue [ edit] The tongue is a complex organ composed of muscles, minor salivary glands, papillae, sensory and motor nerve fibers, blood vessels, adipose tissues, etc., This wide variety of tissues poses. Semin Neurol. 8600 Rockville Pike A black hairy tongue in the setting of chronic administration of penicillins is often fungal overgrowth, particularly ofaspergillus. 2005 Jul. Centers for Disease Control and Prevention. This theory has been discarded, however, and median rhomboid glossitis is now considered a form of erythematous candidiasis.5,16 Central papillary atrophy and posterior midline atrophic candidiasis are other names for this condition.16. Lingual nerve involvement may manifest as an altered sensation in the tongue. Deviation was always to the side of the limb weakness. M.J. has experienced some of the above symptoms, including fatigue, weakness, shortness of breath and pallor. 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. Herpetiform ulcers are pin-point size, often multiple, and may coalesce to form a larger ulcer. It may be pinkish-red in color. Trending Clinical Topic: Periodontal Disease, Fast Five Quiz: Test Yourself on Temporomandibular Disorder, Dental Management in the Medically Compromised Patient, Bacteremia, Antibodies Link Periodontal Disease to RA Development and Activity, Tackling Oral Health in Primary Care: A Task That's Worth the Time, Tiny Robots Could Someday Brush, Floss Your Teeth for You, 2016 in Review: Key Guidelines in Anesthesiology You Need to Know, Free NHS Dental Treatment for Young People in Scotland. Systematic analysis of clinical deficits in unilateral hypoglossal nerve palsy. Share cases and questions with Physicians on Medscape consult. J Oral Maxillofac Surg. https://www.physio-pedia.com/index.php?title=Hypoglossal_Nerve&oldid=267232, Infranuclear and nuclear lesions cause weakness of the tongue but additionally cause ipsilateral atrophy. eCollection 2022 Sep. Smaoui S, Peladeau-Pigeon M, Mancopes R, Sutton D, Richardson D, Steele CM. It is also possible that geographic tongue may not recur after the initial episode. doi: 10.12659/AJCR.936511. The extraocular motility and alignment should be examined in all gaze positions, with particular focus on positions opposite to those favored. It supplies into the tongue, There are two hypoglossal nerves in the body: one on the left, and one on the right.[1]. 2009 Oct 15. An interesting illustration of the physical exam. 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. 2019 Sep;15(3):494-497. doi: 10.1007/s12024-018-0045-0. 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. PMC Learn how doctors should perform a bedside swallow evaluation! Over 90% of oral cancers are squamous cell carcinomas (OSCCs) which are of epithelial origin. Geographic tongue is a benign condition in which discolored, painless patches of the tongue appear and then reappear from atrophy, often in a different distribution. The finding that it occurs relatively commonly in large (non-lacunar) infarcts and its association with dysphagia may have clinical utility. Save my name, email, and website in this browser for the next time I comment. Oral Hairy Leukoplakia, in an HIV-positive individual. Reamy BV, Derby R, Bunt CW. Cranial nerve XII: the hypoglossal nerve. This presents with a small, stiff tongue. Median rhomboid glossitis: a clinical and microbiological study. Since there are a lot of different conditions that often share similar symptoms, your provider will create a differential diagnosis, which is a list of possible conditions that could cause your symptoms. Asthma Symptoms of asthma include shortness of breath, wheezing, pain or a tight feeling in your chest and coughing. Your provider will compile a list of potential conditions that relate to your symptoms. Course of oral lichen planus: a retrospective study of 808 northern Italian patients. Key Diagnostic Features: Hemiatrophy of the tongue, with fatty replacement of the tongue muscles (high signal intensity on T1 and T2 and no enhancement), is one of the most important radiologic features of hypoglossal nerve palsy. Epub 2012 Sep 9. tongue deviation differential diagnosis. The association between geographic tongue and pustular psoriasis has been investigated most closely, with conclusions suggesting that the presence of geographic tongue in an otherwise healthy individual may indicate a greater risk of generalized psoriasis.6 Systemic conditions such as diabetes, Reiters syndrome and Down syndrome appear to have a possible correlation with geographic tongue. The process to make an accurate diagnosis, especially with more complex conditions, can take time and doesnt happen immediately. Melanocytic macule. Melkersson-Rosenthal syndrome and orofacial granulomatosis. Happy Halloween! It may arise away from the midline, as well.17 The affected area may vary in size between 1 cm and 2.5 cm. The site is secure. Epub 2022 Dec 8. Accept Neville BW, Damm DD, Allen CM and Bouquot JE. It is necessary in many functions, including the synthesis of both DNA, RNA and myelin production, particularly in the spinal cord. With the help of additional testing, the likelihood of error after following the diagnostic process significantly reduces. government site. The tongue may be involved by many organic disorders and particularly weakness; in this respect, "wrong-way" tongue deviation is helpful to diagnose functional tongue deviations ( Keane, 1986). Philadelphia: Wolters Kluwer Health, 2016. 300 patients with acute unilateral ischaemic motor strokes (excluding those in the lower brainstem) and an equal number of normal controls were studied for the presence of tongue deviation in a standardised manner. 1173185. physiotutors.Cranial Nerve 12 | Hypoglossal Nerve Assessment for Physiotherapists. It's important to bring a list of any medications, vitamins or supplements that you take with you when you visit your providers office so they can keep a record to make sure your medications are not influencing your symptoms. Melkersson-Rosenthal syndrome in childhood: successful management with combination steroid and minocycline therapy. Differential diagnosis of cranial nerve lesions includes central and peripheral causes. Your symptoms increase in severity or go away. Follow-Up Questions. Epub 2010 Jan 13. At this stage in the diagnostic process, your healthcare provider will offer tests as a process of elimination to narrow down your specific diagnosis. Belmont Publications, Inc. is an ADA CERP-Recognized Provider. 2. This site needs JavaScript to work properly. Its association with autoimmunity is most plausible. Pancreatitis. Differential Diagnosis on the basis of Rigidity and Fever; Disease Diagnosis Treatment Symptoms Signs . Am J Case Rep. 2022 Jun 8;23:e936511. K14.8 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Dental professionals frequently encounter oral lesions in practice and reaching a diagnosis requires clinicians to take a thorough medical history and perform an in-depth oral examination. Because of the extensive interlacing of muscle fibers, the functional deficit with unilateral tongue weakness is usually minimal. Occlusion of large vessels in this system usually leads to major disability. Soft, lumpy foods, ground meats, and foods that dissolve in saliva (such as . Unauthorized use of these marks is strictly prohibited. Stanford Medicine 25 Launches New Website, Medical Errors and Adverse Events from a Missed or Inadequate Physical Exam, Announcing the Stanford 25 Skills Symposium, Thyroid Nodule Overview - The Thyroid Exam. Therefore it should be considered in differential diagnosis. Merck Manual. Would you like email updates of new search results? Exploring the pivotal variables of tongue diagnosis between patients with acute ischemic stroke and health participants. A differential diagnosis of chest pain includes: Symptoms of a cough include clearing your throat of mucus or fluids and clearing your throat of dry air, irritation or tickle in the back of your throat. -, Neurocrit Care. In this article we summarise an approach to the assessment and diagnosis of functional symptoms in neurology, paying attention to those symptoms that are particularly "neurological", such as paralysis and epileptic-like attacks. 2010 Mar 1. Common tongue conditions in primary care. when do starlings start talking. official website and that any information you provide is encrypted The current term of approval extends from 7/1/2021-6/30/2023. Carbone M, Arduino PG, Carrozzo M, et al. Pink-red on dorsal and ventral surfaces. A proper workup, which may include fine needle aspiration of the mass, is necessary for diagnosis. The ventral surface may have some visible vasculature. Tongue diagnosis is one of those ways. The patient presents with painless, white plaques on the tongue or oropharynx which are easily scraped off. Diagnostic Considerations. (1,2) Whether this is toward or away from the side of the lesion depends on the specifics of the lesion. A classic smooth, beefy red tongue from vitamin B12 deficiency (Credit). (5) This should not be confused with a medial medullary lesion. A bright pink color on the tongue is most often due to a deficiency in iron, folic acid, or vitamin B-12. 1996. Sometimes the sore will bleed if you touch or bite it.. [Pathologic changes in the tongue as signs of systemic diseases]. Physical exam may reveal a tender lump in the tongue on palpation, however physical examination may not reveal anything if the mass is toward the posterior end of the tongue. Aphthous ulcers, or aphthous stomatitis, are a painful form of ulcer that is frequently encountered. DYSARTHRIAS: DIFFERENTIAL DIAGNOSIS | Julie A.G. Stierwalt, Ph.D. Mayo Clinic The Dysarthrias "A collective name for a group of neurologic speech disorders resulting from abnormalities in the strength, speed, range, steadiness, tone, or accuracy of movements required for control . A contribution to the differential diagnosis of ulcerative mucosal changes in HIV-infected patients]. Although the tongue is primarily composed of muscle tissue, most pathologic lesions arise from the cells of the surface epithelium, which covers the tongue, and blood vessels.2 This article describes a few of the most common benign conditions that affect the tongue. Kovac-Kovacic M, Skaleric U. Read more, Physiopedia 2023 | Physiopedia is a registered charity in the UK, no. There are several steps your healthcare provider will take to make an accurate diagnosis including: A differential diagnosis occurs when your symptoms match more than one condition and additional tests are necessary before making an accurate diagnosis. Patient history and risk factors are important to note. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation, mask requirements and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. What is it? Oral Surg Oral Med Oral Pathol Oral Radiol Endod. HHS Vulnerability Disclosure, Help Yarom N, Cantony U, Gorsky M. Prevalence of fissured tongue, geographic tongue and median rhomboid glossitis among Israeli adults of different ethnic origins. Oral candidiasis, or thrush, is the result of infection of the oropharynx byCandida albicans. [QxMD MEDLINE Link]. Robert D Kelsch, DMD is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology, American Dental AssociationDisclosure: Nothing to disclose. Cullins MJ, Lenell C, Ciucci MR, Connor NP. Sublingual glands should not be displaced. Umapathi T, Venketasubramanian N, Leck KJ, et al. Lesions appear as red patches surrounded by elevated, thin, white-to-yellow borders (Figure 1 and Figure 2).9 Lesions can also be multifocal. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. Causes vary according to which cranial nerve is affected, and whether multiple cranial nerves are involved. Please check your email and click the confirmation button so we can send you your free blood pressure table! This is a normal tongue pattern observed in early chewing. 2004. Several conditions should be included in the differential diagnosis of frictional keratosis in both children and adults. This is most typically in patients with some form of immunocompromise, particularly HIV, diabetes, or chronic antibiotic use, which leads to fungal overgrowth. In this chapter, we describe the clinical characteristics of early- and advanced-stage OSCC and also consider the differential diagnosis of early-stage OSCC. Nelson BL, Thompson L. Median rhomboid glossitis. Would you like email updates of new search results? The process of tongue diagnosis is relatively quick. Next is its size. Weakness of the arm was significantly associated with presence of tongue deviation. In refractory cases, the use of other topical or systemic immunomodulators and retinoids has been tried. [QxMD MEDLINE Link]. J Stroke Cerebrovasc Dis. Can look at tip of nose (Y/N) . An allergic reaction to gluten can also cause this. Common oral lesions: Part I. Superficial mucosal lesions. The process begins during an exam when they'll ask questions related to your condition including: Next, your healthcare provider will review your medical history to see if the symptoms connect to any previous health concerns or already diagnosed conditions. Have the patient protrude the tongue straight out and inspect for deviation, color, texture, and masses. Clipboard, Search History, and several other advanced features are temporarily unavailable. Learn more about Cleveland Clinic initiatives to prevent illness and foster health. Familiarity with common characteristics of oral lesions in regard to color, shape, size, location and morphology assists practitioners in making an accurate diagnosis. We found dysarthria, and a stiff, small tongue, which deviated to the left on protrusion. Hypoglossal nerves can be damaged unilaterally by a multitude of causes especially, tumors, infection, or trauma. Policy. A patient presents with foot pain and these chronic findings? Diagnostic evaluation may include measuring the degree of head tilt and face turn. 2010 Mar;81(3):267. doi: 10.1016/j.resuscitation.2009.12.013. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTA3ODUzNi1kaWZmZXJlbnRpYWw=. Cranial Nerve 4. Neurophysiol Clin. Each diagnosis is dependent on the symptoms and complexity of the condition that might be causing them, so there is no set timeline as to when you will know your results. Michael J Wells, MD, FAAD Dermatologic/Mohs Surgeon, The Surgery Center at Plano Dermatology The lateral borders and tip of the tongue remain uninvolved.5, The etiology for hairy tongue is not well understood. New-onset fasciculations are concerning for amyotrophic lateral sclerosis. These are your clinical examination findings: weakness of the left upper and lower limbs, with sparing of the face. Normal variations of oral anatomy and common oral soft tissue lesions: evaluation and management. 2023 Feb 15;439:114252. doi: 10.1016/j.bbr.2022.114252. Dar-Odeh NS, Hayajneh WA, Abu-Hammad OA, et al. After the official diagnosis, your healthcare provider will recommend treatment options. According to the National Health and Nutrition Examination Survey (NHANES), the prevalence of tongue lesions at any given time is 15.5%.1 Many large scale, population-based screenings have identified the most common conditions affecting the tongue, however, these were performed on specific groups and the data may vary based on the population studied and assessment method.2,3. 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. 2022 Apr 7;12(5):505-510. doi: 10.1016/j.jtcme.2022.04.001. Gastritis. Eidelman E, Chosack A, Cohen T. Scrotal tongue and geographic tongue: polygenic and associated traits. The clinical appearance of geographic tongue can range from minimally evident to very prominent. The tongue is made up of a mobile group of muscles that are attached to the floor of the mouth. Cranial nerve XII innervates the left and right genioglossus muscles. 3(1):37. (4) Keane reported four cases of wrong way tongue deviation toward the normal side rather than the hemiparetic side in functional hemiparesis. 63(7):1035-9. Cranial nerve palsy is characterized by a decreased or complete loss of function of one or more cranial nerves. Following an evaluation, your healthcare provider might order laboratory or imaging tests to confirm diagnostic theories that will pinpoint which condition is most accurate. 1 0 obj <> endobj 2 0 obj <> endobj 4 0 obj <>/Type /Page>> endobj 7 0 obj <> stream Referred to as the kissing lesion, the presence of this condition is presumed by some to be a marker of immunosuppression and acquired immunodeficiency syndrome.16 The lesion may be caused by prolonged contact between the two anatomic locations, however.17 While patients with median rhomboid glossitis are generally asymptomatic, complaints of pain, burning, irritation or itching have been reported.17, Because the clinical presentation of median rhomboid glossitis is most often evident, clinicians may consider empirical treatment with antifungal agents. *V"^@mvvfvvwg'#4h!Pre[g/B{r\rYSu|_*~aoMt*tTf_uvuWt>5Z0M0&{|7Zf^1;F X>2kr =kB5258,A4F$Ps6juJU q1ivgg[w~/>F}|>;K?/'=3wwO)` @~`p`x]Ad1h :`4N Int J Environ Res Public Health. Before [QxMD MEDLINE Link]. During a differential diagnosis, it might be daunting to see a list of possible conditions that could cause your symptoms. Tongue weakness may result from a supranuclear, nuclear, or infranuclear lesions. Prevalence and risk factors associated with geographic tongue among U.S. adults. 2014;23:e405-e406. Accurately diagnosing common lesions will allow appropriate management and help rule out malignancies. construction grammar theory does homeowners insurance cover pool damage state farm. It is generally believed that the supranuclear innervation of the hypoglossal nucleus is bilateral and symmetrical. Am Fam Physician. An official website of the United States government. Although oral lichen planus is more frequently diagnosed in patients older than 40, it can affect children and young adults as well. Tongue deviation towards lesion; Inferior ASA. Please enable it to take advantage of the complete set of features! Questions about your medical history include: Last, your healthcare provider will perform a physical examination by checking your blood pressure, heart rate and listening to your lungs. Microcopy Introduces the NeoDiamond X-Class, Zest Dental Solutions Launches Fully Guided Surgical Kit for Full-Arch Solutions, Ultradent Introduces J-Temp A Light-Cured, Premixed Temporary Resin. A differential diagnosis of depression includes: Symptoms of elevated alkaline phosphatase include stomach or abdominal pain, nausea and vomiting and a yellow color to the skin (jaundice). Courtesy of Kozlovsk (own work), via Wikimedia Commons. It is one step that your healthcare provider will take before making a final diagnosis. loss of vibration and proprioception in the left upper and lower limbs. A differential diagnosis of asthma includes: Symptoms of back pain include aching, burning or sharp, stabbing pain that increases when standing, walking, lifting objects or twisting. Fasciculations of the tongue are indicative of lower motor neuron injury. 1996 Aug;82(2):119-21. doi: 10.1016/s1079-2104(96)80213-7.