Oculopalatal tremor following sequential medullary infarcts that did not cause hypertrophic olivary degeneration.

Contemporary theories have emphasized the role of cerebellar maladaptation in "shaping" oscillations generated elsewhere, the inferior olive in particular. Our patient and published Alexander disease cases illustrate that oculopalatal tremor can occur in the absence of hypertrophic olivary degeneration. Therefore, cerebellar maladaptation to any form of olivary damage may be the critical pathophysiology in producing oculopalatal tremor.