Objective: To describe an unusual presentation of essential palatal tremor manifesting as vocal tremor and to discuss its diagnostic considerations and therapeutic response to propranolol.

Background: Palatal tremor (PT) is a rare hyperkinetic movement disorder characterized by rhythmic, involuntary contractions of the soft palate. It is classified into Symptomatic Palatal Tremor (SPT), associated with structural lesions in the Guillain-Mollaret triangle, and Essential Palatal Tremor (EPT), which lacks identifiable structural deficits

Method: A case report of a 63-year-old woman presenting with a two-year history of vocal tremor. Clinical history and neurological examination were performed to identify associated symptoms and signs of palatal tremor. Brain magnetic resonance imaging (MRI) was conducted to evaluate possible structural abnormalities involving the brainstem, cerebellum, and dentato-rubro-olivary pathway. The patient received symptomatic treatment with propranolol 10 mg twice daily, and clinical response was observed during follow-up.

Results: The patient initially experienced intermittent vocal tremor triggered by emotional states such as sadness or anger, which progressed to a persistent condition over the past month. Clinical examination revealed vocal tremor, objective ear clicks, and rhythmic palatal contractions present during both silence and speech. Neurological examination confirmed findings consistent with palatal tremor. Brain MRI showed no structural abnormalities or signal changes in the brainstem, cerebellum, or dentato-rubro-olivary tract. Following treatment with propranolol 10 mg twice daily, the patient demonstrated significant clinical improvement in tremor symptoms.

Conclusion: This case highlights PT with emotional triggers suggest a dysfunction in emotional processing mediated by complex interplay between the limbic system and motor pathways and on-selective beta-blockers like Propranolol provide a valuable therapeutic option by targeting both central and peripheral tremor mechanisms that demonstrated significant clinical improvement.

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5. Zhou J, Van der Heijden ME, Salazar Leon LE, et al. Propranolol Modulates Cerebellar Circuit Activity and Reduces Tremor. Cells. 2022;11(23):3889.
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MDS Abstracts - https://www.mdsabstracts.org/abstract/vocal-tremor-as-the-initial-manifestation-of-palatal-tremor-with-response-to-propranolol-a-case-report/