Oculopalatal tremor

Oculopalatal tremor (OPT) should be considered in any patient who has pendular nystagmus. In these patients, the examiner should always evaluate for palatal tremor (with a resting palate), which confirms the diagnosis of OPT. This disorder often occurs months following a pontine hemorrhage involving the central tegmental tract (CTT, which was the culprit in this patient), which is part of the Guillain Mollaret triangle (connecting ipsilateral medullary inferior olive to contralateral cerebellar dentate nucleus and then wrapping around ipsilateral midbrain red nucleus and descending via ipsilateral CTT). However, a lesion anywhere within this triangle can cause OPT. Pendular nystagmus tends to be relatively slow/low frequency, and vertical, torsional or vertical and torsional.