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Bilateral hypertrophic olivary degeneration in symptomatic palatal tremor
  1. Thomas B Stoker
  1. Department of Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  1. Correspondence to Dr Thomas B Stoker, Department of Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK; tbs26{at}

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A 78-year-old man had variable slurring of speech for 1 month, with swallowing difficulty. His medical history included ulcerative colitis, hypertension, aortic valve disease, ischaemic heart disease and a transient ischaemic attack several years before.

On examination, there were rhythmic movements of his palate, with an approximate frequency of 2 Hz (figure 1, online supplemental video 1). There were rhythmic breaks in his voice when trying to sustain a vocal tone (online supplemental video 2). He could not perform tandem gait, but there was no appendicular ataxia. The remaining neurological examination was normal. MR scan of the brain showed hypertrophic degeneration of the inferior olivary nuclei, but with no identified specific cause (figure 2). He was diagnosed with palatal tremor.

Supplementary video


Supplementary video


Figure 1

Still image from online supplemental video 1 …

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  • Contributors The author performed the literature search and wrote and revised the manuscript.

  • Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned. Externally peer reviewed by Pushkar Shah, Glasgow, UK.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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