Neurosyphilis orofacial dyskinesia: the candy sign.

A recent review of movement disorders relating to syphilis has illustrated their considerable variety, the most frequent being parkinsonism and more rarely, chorea, dystonia, ataxia, and myoclonus.[1] Not surprisingly, a similar phenomenological variety has been observed with regard to orofacial movement disorders in syphilis, which have been described as “dysarthria and tremor prevailing in the labiolingual region” (author's translation),[2] ”facial, lingual, and hand tremor,”[3] “twitching of face and tongue” resulting in dysarthria and buccolingual masticatory movements,[4] or facial grimacing.[5] Orofacial chorea is well described in neurosyphilis and the terms trombone tremor of the tongue or trombone tongue have been used to describe a focal chorea, without persistence of tongue protrusion.[6] Here we illustrate a distinct phenomenological presentation of the wide spectrum of oral neurosyphilic dyskinesias, namely, the candy sign.