Oculopalatal tremor and severe late-onset cerebellar ataxia

Oculopalatal tremor and severe late-onset cerebellar ataxia Following four recurrent bleedings of a mesencephalic cavernoma within 10 years (figure 1A), a 62-year-old woman demonstrated left kinetic cerebellar syndrome.She then developed oculopalatal tremor (OPT) associated with bilateral inferior olive hyperintensity (figure 1B).Gamma knife radiation was performed, but she developed severe cerebellar ataxia.OPT secondary to brainstem strokes and associated with progressive ataxia is rare. 1 Diffusion tensor MRI (DTI) showed decreased number of fibers in the right tegmentum of the patient as compared to a control subject (figure 2).These results give credit to the hypothesis of central tegmental tract interruption in pathophysiology of OPT (figure 1C).