Case examples of Palatal Myoclonus (PM)

Timothy C. Hain, MD Palatal Myoclonus main page Page last modified: November 16, 2009

Case ID #	Cause	Onset Age/Gender	Nystagmus type(s)
9263	Unknown	68/M	Vertical pendular, downbeating
7676	Pontine AVM	72/F	Horizontal pendular
0216	Cerebellar Degeneration	30's/F	Unknown
5511	Unknown (atrial fib)	60's/M	Torsional pendular
6792	Unknown (atrial fib)	76/M	Torsional pendular
2617	Brainstem hemmorage	60's/M	Vertical pendular
9129	Brainstem hemmorage	27/M	Vertical pendular, horizontal jerk
1198	CNS degeneration	66/M	Vertical pendular, Rebound
2808	CP angle meningioma	49/F	None

Links: palatal myoclonus page movie of ocular nystagmus movie of palate (case 9263) movie of palate (case 1198)

Case 7676: A 72 year old woman first came to medical attention when she developed inward turning of her left eye. An MRI scan was obtained which documented a vascular malformation in her pons. An operation was attempted, following which she developed near complete paralysis of horizontal eye movements. Balance was poor and one eye began to "bob". On an examination done one year later, there was a constant pendular (sinusoidal) nystagmus of one eye, severe unsteadiness, and a one cycle/second up and downward movement of the soft palate (palatal myoclonus), accompanied by contractions of muscles in the throat. The combination of the "bobbing" ocular nystagmus and palatal myoclonus, defines a case of OPM. The cause is presumably related to interruption of the central tegmental tract

Case 5511. A man in his 60's began to develop disturbance of his speech. His health was otherwise good, except for atrial fibrillation. Neurological examination documented palatal myoclonus. Over several years, he gradually developed imbalance, and a subtle torsional pendular nystagmus was eventually documented. MRI scanning, intially read as normal, documented hypertrophy of both inferior olivary nuclei on review by a neuroradiologist familar with OPM. One of his cardiac medications was stopped because of concern that it might be the cause of his PM. His PM and nystagmus disappeared several years after his cardiac antiarrythmic was stopped.

Case 6792. A man in his 70's presented for an evaluation of ataxia. His health was also affected by atrial fibrillation and a monoclonal gammopathy, neither of which were seriously disturbing to him. He was taking amiodarone for his atrial fibrillation. Examination documented a torsional pendular nystagmus and palatal myoclonus.

Case 2808. A woman had a large CP angle menigioma removed via a transmastoid approach. Post-operatively she was deaf on the side of the tumor and had facial weakness. Two to three weeks later palatal myoclonus ensued. Multiple MRI scans showed no superior olivary hypertrophy. No nystagmus was observed using very sensitive recording methods. Comment: The mechanism of PM in this patient seems unlikely to be related to a lesion in the Guillain Mollaret triangle as MRI shows no lesion or olivary hypertrophy.