Oculopalatal Tremor

Synonyms:

OPT, formerly oculopalatal myoclonus a.k.a. palatal tremour formerly palatal myoclonus

Diagnosis:

Clinical diagnosis

Clinical features:

  • Soft ear clicks heard by patient & examiner. Oscillopsia
  • Symmetrical palatal tremour (levator veli palatini muscle)
  • +Ocular nystagmus: pendular (same speed in both phases), usually vertical (may be tosional) & sometimes horisontal. May be bilateral or unilateral i.e. dissociated.

MRI & MRA:

  • Lesion in dentato-rubro-olivary pathway (Guillain-Mollaret triangle) which lies in the brainstem tegmentum
  • Hypertrophic olivary degeneration (unilateral or bilateral): high signal on T2 or proton density, this may return to normal
  • Typically develops 2–49 months after the initial insult

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