Objective:
To study the clinical and neuroimaging features of patients presenting with palatal tremor following cerebellar stroke.

Background:
“Palatal Tremor” (PT) is recognised as one of the rare movement disorders (1).It exists in two variations namely, the“essential palatal tremor” (EPT) and the “symptomatic palatal tremor (2).Brainstem strokes represent 60–70% of cases of symptomatic palatal tremor (3).

Method:
It is a prospective study of five patients of cerebellar stroke who presented with symptomatic palatal tremor were recruited through neurology out-patient clinic.

Results: The ratio of males and females was 3:2. The age group of patients ranged from 34-74 (mean ± standard deviation: 59.2 ± 15.83) years.There were three patients with ischemic stroke and two with haemorrhagic stroke. In all patient’s palatal tremor was detected on examination. The duration of presentation of palatal tremor after onset of stroke varied from five months to eight years(mean ± standard deviation: 27.80± 38.43 months) in our patients. None of our patients had ear clicks. Dystonia of bilateral upper limbs was another common abnormal movement that was noticed in our patients. The lesions on imaging were mainly localised to cerebellum in all patients, although bilateral cerebellar infarct was seen in one patient.

Conclusion:
Palatal tremor can be a delayed manifestation of lesions to the ‘Guillain–Mollaret triangle’and hence this cryptic neurological finding should specifically be looked for in patients with cerebellar stroke. Dystonia of upper limbs was also noted in our patients, thereby emphasizing the role of cerebellum in the pathogenesis of dystonia.
 

This abstract was presented at the Annual conference of Movement disorders society of India-2020, held on 1^st of February 2020.

References: 1) Politzer A. Lehrbuch der Ohrenheilkunde. Wien: Urban and Schwarzenberg, Stuttgart, Germany; 1878. 2) Deuschl G, Wilms H. Clinical spectrum and physiology of palatal tremor. Mov Disord 2002;17:(Suppl 2): S63-S66. 3) Shaikh AG, Hong S, Liao K, et al. Oculopalatal tremor explained by a model of inferior olivary hypertrophy and cerebellar plasticity. Brain2010;133(Pt3):923–40.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/symptomatic-palatal-tremor-following-cerebellar-stroke-clinical-and-neuroimaging-features/