Atypical oculopalatal tremor as the presentation of vertebral artery dolichoectasia

Abstract

Vertebrobasilar dolichoectasia (VBD) is a rare dilative arteriopathy defined as elongation or widening of the intracranial vertebral and/or basilar arteries. The prevalence ranges from 0.06% to 5.8%. The majority of VBDs are asymptomatic. Downbeat nystagmus has been reported as a component of an infrequent ocular movement disorder in VBD. Nevertheless, oculopalatal tremor (OPT), delayed sequelae of a brainstem lesion, has never been demonstrated in VBD cases. Synchronized rhythmic involuntary contractions of the soft palate with an ocular pendular nystagmus, predominantly vertical pendular nystagmus, are the hallmark presentation. Our case demonstrated a 50-year-old female who presented with 3-month history of oscillopsia. Examination showed binocular conjugate torsional jerk nystagmus simultaneous with a contraction of the soft palate, defined as an atypical OPT, resulting from dolichoectatic left vertebral artery compressing on medulla, demonstrated by magnetic resonance imaging. Bilateral conjugate torsional jerk nystagmus simultaneous with palatal tremor, considering as an atypical OPT, should be included as one of the symptomatic presentations of vertebral artery dolichoectasia in spite of its rarity.

Palatal Tremor – Pathophysiology, Clinical Features, Investigations, Management and Future Challenges

“…PAPT shows the relentless progression of ataxia. Sporadic PAPT reveals abnormal eye findings (saccadic pursuit, pendular nystagmus), oscillopsia and progressive ataxia EPT can be distinguished from the SPT by the presence of an audible click, the variability of the tremors, the • Basilar artery occlusion [36] • Brainstem or cerebellar infarct/bleed/tumor • Vertebral artery dolichectasia [37] • Vascular malformation (Arteriovenous malformation, aneurysm) [24][25][26][27][28]38] II) Inflammatory/Demyelinating:…”