Essential palatal tremor: a case report and literature review / 中华神经科杂志

Essential palatal tremor is relatively rare in clinical practice, which manifests involuntary and rhythmic contraction of soft-palate along with auditory click. The cause is unknown and there is no specific treatment at present. This article reports a female patient with essential palatine tremor, who presented with involuntarily beating of soft palate, disappeared during sleep, had sensory tricks, and gradually developed mental and psychological problems such as anxiety disorders. After treatment with integrated traditional Chinese and Western medicine, the symptoms improved. The clinical features of the case were analyzed, relevant literature was reviewed, and the possible etiology and characteristics of the disease were explored, so as to provide reference for clinical diagnosis and treatment.

Motor Symptoms in Brain Stem Lesion

Palatal tremor and Kernohan-Woltman notch phenomenon are rare motor symptoms that can show up in patients with lesion in brain stem or cerebellum. Patients with palatal tremor accompany ataxia, internuclear ophthalmoplegia, dysphagia, dysarthria and Kernohan-Woltman notch phenomenon causes ipsilateral motor deficits. Although its rarity, these conditions exhibit unexpected symptoms as well as considerable disability, which can raise etiologic and prognostic concerns for rehabilitation team. These two motor symptoms are discussed in this review.

Clinical and Imaging Features of Hypertrophic Olivary Degeneration Secondary to Brainstem Hemorrhage：1 Case Report / 中国康复理论与实践

Objective To investigate the clinical and imaging features of hypertrophic olivary degeneration (HOD) secondary to brain-stem hemorrhage. Methods The clinical data of one patient with HOD secondary to brainstem hemorrhage was retrospectively analyzed. Re-sults The patient was hospitalized with paroxysmal and body involuntary jitter and other extrapyramidal symptoms. After admission, MRI scan showed bilateral inferior olive nucleus of medulla oblongata were localized hypertrophy. Conclusion The main clinical manifestation of HOD secondary to brainstem hemorrhage is extrapyramidal symptom. The imaging features are abnormal signals and localized hypertro-phy at inferior olive nucleus.

A Case of Progressive Ataxia and Palatal Tremor

Progressive ataxia and palatal tremor (PAPT) is a subgroup of symptomatic palatal tremors which is characterized by palatal tremor and idiopathic progressive cerebellar ataxia. Here, we report a 59 year-old-male who presented with a 5 months history of progressive cerebellar ataxia, and was discovered to have both a symptomatic palatal tremor and torsional nystagmus. Various studies searching for the cause of the ataxia and the palatal tremor all came out negative, thus defining this patient as a PAPT.

3-Dimensional Analyses of Eye Motion in Oculopalatal Tremor

BACKGROUND: Oculopalatal tremor (OPT) is a delayed complication of damage to the dentato-rubro-olivary pathway (Guillain-Mollaret triangle) and subsequent hypertrophic olivary degeneration. Mixed torsional-vertical pendular nystagmus in OPT has been considered to signify unilateral brainstem damage while symmetrical vertical nystagmus has been regarded to indicate bilateral disease. However, 3-dimensional oculographic analysis of OPT has been sparse. METHODS: In 8 patients with OPT; binocular 3-dimensional analyses of ocular oscillations were performed by using a magnetic search coil technique. Lateralization of the lesions was determined by the imaged olivary hypertrophy in the MRI. RESULTS: One patient had conjugate vertical pendular nystagmus and four showed mixed torsional-vertical pendular nystagmus. Two patients showed mixed horizontal-torsional-vertical nystagmus. One patient had predominantly horizontal pendular nystagmus. MRI demonstrated increased signal or hypertrophy of the inferior olivary nucleus, unilateral in six and bilateral in two. Unilateral olivary changes were associated with mixed torsional-vertical nystagmus in three patients, mixed horizontal-torsional-vertical nystagmus in another two patients, and predominantly horizontal pendular nystagmus in the remaining one patient. Bilateral olivary changes were visible in one patient with conjugate vertical pendular nystagmus and in the other patient with mixed torsional-vertical nystagmus. Palatal tremor appeared to be symmetrical in all patients. CONCLUSIONS: Three-dimensional analyses of OPT indicate that conjugate vertical and mixed torsional-vertical pendular nystagmus do not correspond to the laterality of signal changes in the inferior olivary nucleus. Ocular oscillations often have all the vertical, horizontal and torsional components.

Symptomatic Palatal Tremor Associated with Cerebellar Hemorrhage: A Case Report

Palatal tremor is a rare disorder characterized by involuntary rhythmic movements of the soft palate. Palatal tremor is devided into symptomatic palatal tremor(SPT) and essential palatal tremor(EPT) on the basis of clinical features. SPT is associated with brain stem or cerebellar disease, whereas the EPT has no known etiology. Reverberant neural activity in the region of the brain stem or cerebellum within the Guillain-Mollaret triangle is believed to underlie SPT. We present a case of SPT associated with cerebellar lesion. Electromyographic recording from the levator veli palatini muscle and voice spectrogram analysis showed abnormal bursting activity time locked to the palatal movements. Botulinum toxin was injected into the levator veli palatini muscle to reduce the voice tremor. The pathology and management of this condition is briefly discussed.