Palatal tremor as a presenting symptom of amyotrophic lateral sclerosis

Palatal tremor, also known as palatal myoclonus, is a sign caused by a lesion to the Guillain-Mollaret triangle. In some cases, imaging may also reveal hypertrophic olivary degeneration, which is due to trans-synaptic degeneration and gliosis of the inferior olivary nucleus. The underlying etiology is commonly due to unilateral involvement of the central tegmental tract due to ischemic, neoplastic, demyelinating, traumatic, inflammatory, and rarely neurodegenerative processes such as progressive supranuclear palsy, multiple system atrophy, and Alexander disease.1 We describe a patient who presented with palatal tremor as the presenting symptom of amyotrophic lateral sclerosis (ALS).