title: Atypical oculopalatal tremor as the presentation of vertebral artery dolichoectasia.
abstract: Vertebrobasilar dolichoectasia (VBD) is a rare dilative arteriopathy defined as elongation or widening of the intracranial vertebral and/or basilar arteries. The prevalence ranges from 0.06% to 5.8%. The majority of VBDs are asymptomatic. Downbeat nystagmus has been reported as a component of an infrequent ocular movement disorder in VBD. Nevertheless, oculopalatal tremor (OPT), delayed sequelae of a brainstem lesion, has never been demonstrated in VBD cases. Synchronized rhythmic involuntary contractions of the soft palate with an ocular pendular nystagmus, predominantly vertical pendular nystagmus, are the hallmark presentation. Our case demonstrated a 50-year-old female who presented with 3-month history of oscillopsia. Examination showed binocular conjugate torsional jerk nystagmus simultaneous with a contraction of the soft palate, defined as an atypical OPT, resulting from dolichoectatic left vertebral artery compressing on medulla, demonstrated by magnetic resonance imaging. Bilateral conjugate torsional jerk nystagmus simultaneous with palatal tremor, considering as an atypical OPT, should be included as one of the symptomatic presentations of vertebral artery dolichoectasia in spite of its rarity.
authors.affiliation: Department of Ophthalmology.
authors.forename: Kavin
authors.initials: K
authors.lastname: Vanikieti
authors.affiliation: Department of Radiology.
authors.forename: Piyaphon
authors.initials: P
authors.lastname: Cheecharoen
authors.affiliation: Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University.
authors.forename: Panitha
authors.initials: P
authors.lastname: Jindahra
authors.affiliation: Department of Ophthalmology, Queen Sirikit National Institute of Child Health, Bangkok, Thailand.
authors.forename: Sirin
authors.initials: S
authors.lastname: Lueangaram
authors.affiliation: Department of Ophthalmology.
authors.forename: Tanyatuth
authors.initials: T
authors.lastname: Padungkiatsagul
keywords: oculopalatal tremor; torsional nystagmus; vertebral artery dolichoectasia