A 68 year old woman with a troublesome chin tremor Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology.

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A 68 year old woman with a troublesome chin tremor Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology

Vignette 68 year old woman 1-year history of progressive –dysarthria –dysphagia At clinical examination –unintelligible speech –chin tremor with difficulty in chewing Iodice et al. © 2013 American Academy of Neurology

Video Iodice et al. © 2013 American Academy of Neurology

THE CLONUS OF THE LOWER JAW: AN OLD SIGN THAT COMES BACK The patient was affected by amyotrophic lateral sclerosis (ALS). The chin tremor was a clonus of the lower jaw. Exaggerated jaw jerk may occur in ALS patients. Although the first description of the clonus of the lower jaw in ALS dates back to 1886, this sign is not frequently noticed in clinical practice. Iodice et al. © 2013 American Academy of Neurology