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Complete tongue protrusion palsy due to subsequent cryptogenic cortical strokes

We describe a 76-year-old right-handed man who presented with acute onset of tongue protrusion palsy without additional neurological deficits or pseudobulbar stigmata. He had previously suffered five strokes. Six months prior to this presentation he had an ischaemic stroke in the right precentral gyrus causing dysarthria with slowed tongue movements. However, he was able to protrude his tongue during that admission. MRI at 24 h following his new presentation showed acute left precentral gyrus cortical infarction involving …