REM behaviour disorder preceding palatal tremor

摘要

We present a case of idiopathic REM behaviour disorder (RBD) that preceded the development of palatal tremor and ataxia by 2 years. This association has not been previously described. The syndrome of palatal tremor with ataxia (PAPT) is considered by some authors as a distinct neurodegenerative disease. In our case the combination of RBD, cerebellar and extrapyramidal dysfunction guided our diagnostic thought towards multiple system atrophy (MSA). After a 6-year follow-up, however, there were no signs of autonomic dysfunction, making the diagnosis of MSA unlikely. The case is accompanied by two video sequences; the first displays the RBD and the second the palatal tremor.