Objective: To present an unusual case of symptomatic palatal tremor with parkinsonism.

Background: Palatal tremor is an uncommon movement disorder that presents with recurring rhythmic contractions of the soft palate. Symptomatic palatal tremor is caused by a lesion in the triangle of Guillain and Mollaret and is associated with hypertrophic olivary degeneration that has multiple causes.

Method: Description of case who presented with symptomatic palatal tremor with unilateral limb tremor and parkinsonism.

Results: A 46-year-old man had acute onset of left hemiplegia and diplopia, and diagnosed as right pontine hemorrhage. Symptoms nearly improved after several months of rehabilitation. After 5 months of pontine hemorrhage, he had acutely developed gait disturbance and ataxia of right limbs. Brain magnetic resonance imaging (MRI) showed right medullar infarction. The symptoms also gradually improved over the months, and he was able to walk independently. 9 months after the onset of medullar infarction, he complained of rapidly progressive tremor and gait disturbance. The neurological examination demonstrated palatal tremor and left limb tremor. Palatal tremor and left limb tremor were synchronized with same hertz. In addition, general parkinsonism was observed, which was more severe on the left side. Because of parkinsonism, he were unable to stand or walk alone. Brain MRI showed hypertrophic degeneration of right olivary nucleus. 125I-FP-CIT SPECT showed decreased uptake of tracer in bilateral posterior portion of putamen. Over more than 6 months period, tremor and parkinsonism gradually improved, and he was able to walk alone again.

Conclusion: We report a rare presentation of symptomatic palatal tremor combined with parkinsonism, which were reversibly improved.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/symptomatic-palatal-tremor-combined-with-unilateral-limb-tremor-and-parkinsonism/