Huang Yung-Sheng, Chang Hen-Hong, Chiang John Y, Hsu Po-Chi, Lo Lun-Chien
Graduate Institute of Chinese Medicine, China Medical University, Taichung, Taiwan.
Department of Traditional Chinese Medicine, Changhua Christian Hospital, Changhua, Taiwan.
Front Neurol. 2025 Aug 20;16:1632351. doi: 10.3389/fneur.2025.1632351. eCollection 2025.
With the growing global burden of ischemic stroke in aging populations, there is increasing interest in simple and non-invasive neurological markers to support early risk stratification and functional prognosis. Retroflex tongue (RT) and tongue deviation (TD) are observable signs of cranial nerve dysfunction; however, their comparative predictive value for stroke severity remains unclear.
In this retrospective observational study, 308 older adults (mean age: 69.1 years) hospitalized with ischemic stroke were enrolled. Tongue motor function was evaluated using an automatic tongue diagnosis system (ATDS). Deviation angles were measured, and the presence or absence of RT was assessed by trained traditional Chinese medicine physicians. Stroke severity and functional outcomes were evaluated using the National Institutes of Health Stroke Scale (NIHSS), Barthel Index, and length of hospital stay.
Among the 308 patients, 59 (19.2%) exhibited TD and 249 (80.8%) did not. No significant differences were found in baseline characteristics between TD groups, except for deviation angle (TD: 9.72° ± 8.91° vs. non-TD: 6.40° ± 7.84°, = 0.011). Patients without RT had significantly worse clinical outcomes, including longer hospital stays (32.0 vs. 25.9 days, = 0.007), higher NIHSS scores (14.1 vs. 8.9, < 0.001), and lower Barthel Index scores (18.6 vs. 35.0, < 0.001), compared to those with RT. In contrast, TD showed no significant association with these outcomes. Multivariate regression identified non-RT as an independent predictor of stroke severity. ROC analysis supported the discriminative value of RT (AUC = 0.703 for NIHSS ≥ 9; AUC = 0.712 for Barthel ≤ 17), whereas TD showed poor predictive ability (AUC = 0.524 and 0.570, respectively).
Absence of retroflex tongue is more strongly associated with stroke severity and functional impairment than tongue deviation. As a simple, observable motor sign, RT may serve as a practical bedside indicator for early neurological assessment. However, given its preliminary status, further validation in prospective, multi-center studies is warranted before clinical application.
随着全球老年人群缺血性卒中负担的增加，人们对支持早期风险分层和功能预后的简单非侵入性神经学标志物的兴趣日益浓厚。卷舌（RT）和舌偏（TD）是脑神经功能障碍的可观察体征；然而，它们对卒中严重程度的比较预测价值仍不清楚。
在这项回顾性观察研究中，纳入了308例因缺血性卒中住院的老年人（平均年龄：69.1岁）。使用自动舌诊系统（ATDS）评估舌运动功能。测量偏斜角度，并由训练有素的中医师评估是否存在卷舌。使用美国国立卫生研究院卒中量表（NIHSS）、巴氏指数和住院时间评估卒中严重程度和功能结局。
在308例患者中，59例（19.2%）出现舌偏，249例（80.8%）未出现。除偏斜角度外，舌偏组之间的基线特征未发现显著差异（舌偏：9.72°±8.91° vs. 无舌偏：6.40°±7.84°，P = 0.011）。与有卷舌的患者相比，无卷舌的患者临床结局明显更差，包括住院时间更长（32.0天 vs. 25.9天，P = 0.007）、NIHSS评分更高（14.1 vs. 8.9，P < 0.001）和巴氏指数评分更低（18.6 vs. 35.0，P < 0.001）。相比之下，舌偏与这些结局无显著关联。多变量回归确定无卷舌是卒中严重程度的独立预测因素。ROC分析支持卷舌的鉴别价值（NIHSS≥9时AUC = 0.703；巴氏指数≤17时AUC =
