Natural course of combined limb and palatal tremor caused by cerebellar-brain stem infarction

After infarction of the left superior cerebellar peduncle and dentate nucle us, a patient developed tremor of the left upper limb beginning on the twel fth day followed by palatal tremor appearing 10 months after infarction. Su rface electromyogram revealed a difference in the frequency of the tremor i n the upper limb and soft palate. When the palatal tremor appeared, brain m agnetic resonance T2-weighted images revealed high signal intensity of the contralateral, right inferior olivary nucleus. Subsequently, when the ampli tude of palatal tremor became less severe, the high olivary signal intensit y subsided whereas the hypertrophy of the nucleus remained. This patient pr ovides useful information on the pathogenesis of skeletal and palatal tremo r with brain stem or cerebellar lesions based on the differences in the ons et and frequency of tremors and morphologic changes in the inferior olive.