Daniel R. Gold, DO, Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery, The Johns Hopkins School of Medicine
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.
1, Two patients with palatal tremor and oscillations brought out by eye closure
Daniel R. Gold, D.O.
Spencer S. Eccles Health Sciences Library, University of Utah