A 61-year-old man with previous left cerebellar infarct complained of double vision and dizziness several months postinfarct. Infarct is shown in the figure. Examination showed rotatory nystagmus in all directions of gaze, worse on left gaze (video 1). Oral examination showed palatal tremor (video 2). Oculopalatal tremor (OPT) is thought to result from interruption of connections between the red nucleus (midbrain), dentate nucleus (cerebellum), and inferior olive (medulla).1,2 The most common cause is brainstem infarction or hemorrhage,1 but it has also been observed with multiple sclerosis and other inflammatory entities. OPT usually becomes apparent several months after the injury. Treatment may include gabapentin, memantine, benzodiazepines, and valproic acid.
Image shows the patient's infarct, involving the caudal portion of the left cerebellar hemisphere. Area of involvement corresponds to posterior inferior cerebellar artery territory.
Video 1
Rotatory nystagmus toward the left in all directions of gaze but worse on left and upward gaze. Rotatory nystagmus improved in amplitude and frequency with low dose clonazepam.Download Supplementary Video 1 via http://dx.doi.org/10.1212/006563_Video_1
Video 2
Video shows rhythmic contractions of the soft palate.Download Supplementary Video 2 via http://dx.doi.org/10.1212/006563_Video_2
Author contributions
O. Lawal: study concept and design, acquisition of data, preparation and revision of manuscript. A. Fisayo: clinical care of patient, acquisition of data, revision of manuscript for intellectual content, study supervision.
Study funding
No targeted funding reported.
Disclosure
The authors report no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Teaching slides links.lww.com/WNL/A746
- © 2018 American Academy of Neurology
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