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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.
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.
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