Oculopalatal tremor and hypertrophic olivary degeneration

Background: Oculopalatal tremor is characterized by synchronous occurrence of palatal tremor and pendular nystagmus. Oculopalatal tremor (OPT) follows a destructive lesion in the Guillain- Mollaret triangle (GMT) and is associated with hypertrophic inferior olive degeneration (HOD).

Case presentation: We report a case of 45 yearsold patient with palatal tremor and pendular nystagmus without ear click. He has had a brainstem stroke 11 months back. He had right side pyramidal drift, left side lower motor neuron type facial weakness and left abducens nerve palsy and mild gait ataxia in addition to oculopalatal tremor. MRI showed hypertrophic inferior olive degeneration.

Conclusion: Ear click is an infrequent finding in symptomatic palatal tremor. Additional clinical features may be present in OPT depending on topography of initial structural lesion. There is a wide variety of time intervals between the occurrence of anatomical lesions and recognition of palatal tremor.