PALATAL TREMOR IN A PATIENT WITH PRIMARY INTESTINAL LYMPHOMA

We report the case of a 59-year-old man with primary intestinal T-cell non-Hodgkin's lymphoma who developed abnormal facial twitching synchr onous with small palatal movements induced by attempts at speaking or swallowing. At rest, the electromyogram (EMG) showed no spontaneous mu scular activity. Phonation triggered trains of synchronous, rhythmic E MG bursts at a frequency of 3-4 Hz lasting 10-20 s, with an average bu rst of 150 ms, which simultaneously involved palatal, facial, and neck muscles bilaterally with left-sided pre dominance. An enhanced blink reflex recovery curve was observed after stimulation of either side. B ackaveraging electroencephalographic study revealed no activity that w as time locked with the jerks. Axial T2-weighted magnetic resonance im aging showed an increased signal intensity and bilateral enlargement o f the inferior olives. No antineuronal-specific antibodies were found in the blood or in the cerebrospinal fluid. All of these clinical find ings were consistent with a symptomatic palatal tremor (PT). Because i t was triggered by activation of cranial muscles, we termed this movem ent disorder action PT. To our knowledge, this is the first report of symptomatic PT displaying these features.