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Asymmetrical tongue
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Asymmetrical tongue

I noticed recently that one side of my tongue is obviously larger than the other. I have no idea if it's always been like this. It does not hurt at all, and there is no unusual feeling. Naturally, I did an internet search and the horrifying diagnosis of ALS came up immediately. I have no tongue weakness at all. I can tent both cheeks, have no trouble swallowing or talking that I've noticed. I have had muscle twitching, but no muscle weakness. I guess my question is; in ALS, do the symptoms preclude the atrophy of the tongue, or do the symptoms come after atrophy is evident.  Also, the dividing line separating the two halves of my tongue is not centered and slightly favors the smaller side.  Everything I read says the tongue should be symmpetrical in a healthy person.  Any ideas?
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I am not aware of atrophy of the tongue being a common symptom of ALS - however that doesn't mean it can't happen.

There are some neurological diseases like stroke that can lead to asymmetry.  A referral to a neurologist, and an MRI of the brain would be a reasonable initial test to rule out major diseases like a mass or stroke.  EMG studies can be considered if ALS is suspected.  

I would also obtain imaging of the carotid arteries (either an ultrasound or MRA), which can also exclude carotid stenosis, a risk factor for stroke.

These options can be discussed with your personal physician or neurologist.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_
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I needed to add. I definitely have teeth impressions on the sides of my tonge (both sides, but more predominant on the smaller side).  
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