Palatal Myoclonus Due to Cortical Cavernous Malformation

A 24-year-old woman presented to the emergency department with 3 days of intermittent parasthesias and involuntary rhythmic movements on the right side of her tongue and palate.An MRI examination of her brain showed no brainstem abnormalities but revealed a 1.9-cm cavernous malformation in the left precentral gyrus at the approximate homuncular location of tongue function (Figure 1).She was diagnosed with palatal myoclonus, and her symptoms improved with levetiracetam and oxcarbazepine.She was discharged and obtained an outpatient functional MRI (Figure 2) to determine the safety of resection.Due to ongoing periodic palatal myoclonus, she underwent resection of the cavernous malformation 4 months later with resolution of her symptoms.Palatal myoclonus is typically associated with brainstem lesions, particularly those affecting the dento-rubro-olivary pathway, known as the Guillain-Mollaret triangle. 1Our case highlights that cortical lesions can also cause palatal myoclonus, even in the absence of brainstem abnormalities. 2