What would be the differential and initial workup for tongue fasciculation?  

Tongue atrophy and fasciculations, unless very severe and obvious, can be difficult to determine by clinical exam alone. I have had multiple patients who were told that they have ALS after an inexperienced examiner saw them for an initial visit and thought they had tongue fasciculations without furt...

I just wanted to add to ensure it is true tongue fasciculation. My understanding (someone please correct me if I'm wrong) is that the best way to observe this is when the tongue is resting on the floor of the mouth, NOT when it is protruding. Everyone's tongue 'wiggles' a bit when protrudes.

I agree with all the previous comments. Theoretically, isolated unilateral tongue fasciculations could be caused by anything that induces hypoglossal nerve paresis/palsy. My anecdotal cases involve ICA dissection and leptomeningeal myelomatosis, where the only abnormality in the neurological exam wa...

Brainstem to the upper C spine MRI with GAD. EMG BCS for ALS workup. Of course, a detailed neuro exam is done first.

I completely concur with the prior answers including the differential diagnosis and workup. I would include spinobulbar muscular atrophy (previously known as Kennedy's disease) within the differential diagnosis, especially within the correct clinical context (males with primarily bulbar weakness, as...