E-Pearl of the Week: Bright Tongue Sign

October 2, 2012


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October 2, 2012

Bright Tongue Sign

In patients with amyotrophic lateral sclerosis (ALS), brain magnetic resonance imaging (MRI) may show pronounced hyperintensity of the tongue on T1–weighted sequences, giving the appearance of a "bright tongue". This appearance is caused by fatty replacement of the tongue muscle, which has been chronically denervated due to the effects of motor neuron disease. Other abnormalities of the tongue in ALS on MRI include may include a reduced tongue size, as measured in the sagittal plane, a more square or rectangular shape, and a change in tongue position so that it no longer contacts the hard or soft palate.


  1. Fox MD, Cohen AB. "Bright Tongue Sign" in ALS. Neurology 2012; 79: 1520.
  2. Cha CH, Patten BM. Amyotrophic lateral sclerosis: abnormalities of the tongue on magnetic resonance imaging. Ann Neurol 1989;25:468–472.

Submitted by: Jennifer E. Fugate, DO

Disclosure: Dr. Fugate serves on the editorial team for the Neurology® Resident and Fellow Section.

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