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Progressive Ataxia and Palatal Tremor

Vesna V. Brinar, MD, PhD; Barbara Barun, MD; Ivana Zadro, MD; David Ozretić, MD; Mario Habek, MD
Arch Neurol. 2008;65(9):1248-1249. doi:10.1001/archneur.65.9.1248.
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An otherwise healthy middle-aged woman was experiencing gait instability. Neurological examination revealed truncal ataxia. Family history was negative. Brain and spinal cord 1.5-T magnetic resonance imaging (MRI) was performed and yielded normal results. Thyroid hormone, vitamin B12, and folic acid levels were normal. During the next 4 years, her walking difficulties progressed. She also developed palatal tremor. Repeated brain MRI revealed T2 hyperintensities in both olivary nuclei. Therefore, she was referred to our institution for further evaluation.

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Axial (A) and coronal (B) views of 3-T, T2-weighted brain magnetic resonance imaging showing hyperintensities of the olivary nuclei (arrows).

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