Eye Closure and Oculopalatal Tremor

𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This patient suffered a traumatic brain injury with brainstem injury resulting in damage to Mollaret's triangle and palatal tremor. Inferior olivary hypertrophy was noted on her MRI, although no vertical and/or torsional pendular nystagmus was present even when observing closely with the ophthalmoscope. However, when she was asked to close her eyes, large amplitude vertical ocular oscillations were appreciated. When her eyes were observed with infrared video goggles in the dark, no oscillations were present; therefore, the oscillations seem to result from the eyelid closure itself rather than removal of visual inputs. This phenomenon has been referred to as palato-ocular or simply ocular synchrony, and the exact mechanism is not well understood. It can be seen in patients who have pendular nystagmus at baseline (see https://collections.lib.utah.edu/details?id=1209725 for example of typical oculopalatal tremor [OPT]-related nystagmus), in addition to patients with palatal tremor and inferior olivary hypertrophy who have no spontaneous nystagmus, as in this particular patient. Jacobs L, Bender MB. Palato-ocular synchrony during eyelid closure. Arch Neurol 1976; 33:289-291. 𝗡𝗲𝘂𝗿𝗼-𝗼𝗽𝗵𝘁𝗵𝗮𝗹𝗺𝗼𝗹𝗼𝗴𝘆 𝗮𝗻𝗱 𝗡𝗲𝘂𝗿𝗼-𝗼𝘁𝗼𝗹𝗼𝗴𝘆 𝗧𝗲𝘅𝘁𝗯𝗼𝗼𝗸 𝗟𝗲𝗴𝗲𝗻𝗱: The first patient in this video suffered a traumatic brain injury with brainstem injury resulting in damage to Mollaret's triangle and palatal tremor. Inferior olivary hypertrophy was noted on her MRI, although no vertical and/or torsional pendular nystagmus was present even when observing closely with the ophthalmoscope. However, when she was asked to close her eyes, large amplitude vertical ocular oscillations were appreciated. When her eyes were observed with infrared video goggles in the dark, no oscillations were present; therefore, the oscillations seem to result from the eyelid closure itself rather than removal of visual inputs. A second patient with progressive ataxia and palatal tremor (PAPT) demonstrated the same finding of palato-ocular or simply ocular synchrony, and the exact mechanism is not well understood. It can be seen in patients who have pendular nystagmus at baseline, or in patients with palatal tremor and inferior olivary hypertrophy who have no spontaneous nystagmus, as in these two patients. https://collections.lib.utah.edu/ark:/87278/s68665bw