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Palatal myoclonus--a case report.

H C Chua1, A K Tan, N Venketasubramanian

  • 1Department of Neurology, National Neuroscience Institute, Singapore.

Annals of the Academy of Medicine, Singapore
|November 24, 1999
PubMed
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Palatal myoclonus, often from brainstem lesions, can rarely stem from cortical damage. This case highlights a new infarct potentially disinhibiting an old cerebellar lesion, causing this condition.

Area of Science:

  • Neurology
  • Neuroscience
  • Neuroimaging

Background:

  • Palatal myoclonus typically arises from lesions in the brainstem or cerebellum, affecting the dentato-rubro-olivary pathway.
  • Cortical lesions are an infrequent cause of palatal myoclonus.
  • Cerebral infarcts precipitate palatal myoclonus in approximately 70% of cases.

Observation:

  • A patient presented with palatal myoclonus.
  • The patient had a history of an ipsilateral cerebellar infarct and a recent contralateral subcortical infarct in the corona radiata.
  • Brain magnetic resonance imaging (MRI) revealed no hypertrophy of the inferior olivary nucleus.

Findings:

  • The case suggests a novel mechanism for palatal myoclonus involving a new contralateral infarct disinhibiting a pre-existing ipsilateral cerebellar infarct.

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  • This contrasts with the typical etiology of brainstem or cerebellar lesions.

    • Implications:

    • This case expands the understanding of the pathophysiology of palatal myoclonus, suggesting cortical influences on cerebellar circuits.
    • The findings may prompt further investigation into the role of diaschisis in secondary neurological deficits.
    • Treatment with clonazepam, valproate, and phenytoin was ineffective, indicating potential challenges in managing this specific presentation.