Abstract Details

Title A Rare Case of Progressive Ataxia with Palatal Tremor (PAPT) Associated with Anti-thyroid Peroxidase Antibodies

Topic Movement Disorders

Presentation(s) P6 - Poster Session 6 (11:45 AM-12:45 PM)

Poster/Presentation
Number 5-024

Objective To describe a case of progressive ataxia and palatal tremor associated with anti-thyroid peroxidase (anti-TPO) antibodies. To enhance the learning experience, we will include a video demonstrating the patient's phenomenology before and after treatment as part of this case report.

Background Progressive ataxia with palatal tremor is an uncommon diagnosis, and association with anti-TPO antibodies has not yet been reported in literature. The discovery of elevated levels of serum anti-TPO antibodies and a clear clinical improvement after steroid therapy helps provide further conviction in the diagnosis.

Design/Methods Retrospective chart review of a patient chart who presented to our clinic with progressive ataxia.

Results A 46-year-old left-handed woman presented with a six-year history of progressive gait instability, near falls, oscillopsia, and dizziness. On examination, she displayed torsional nystagmus, spontaneous right lower facial myoclonus, and a persistent, rhythmic tremor of the soft palate. Further evaluation revealed gait ataxia, a positive Romberg’s sign, and right-hand dystonia when distracted. Brain MRI with and without contrast showed no significant structural abnormalities, including in the inferior olives or the Guillain-Mollaret triangle. Laboratory tests revealed an elevated anti-TPO antibody level of 756 IU/mL. She was treated with 1000 mg/day of methylprednisolone for five days, leading to marked improvement in her gait ataxia and balance perception.

Conclusions Movement disorders associated with anti-TPO antibodies are uncommon, and palatal tremor or progressive ataxia is particularly rare or unreported. This case is noteworthy as the presence of anti-TPO antibodies manifested primarily as a movement disorder, without clear signs of encephalopathy, seizures, or thyroid dysfunction, and with no abnormalities in imaging. Progressive ataxia with palatal tremor remains a treatable condition when associated with antibody positivity and neurologists should maintain a high index of suspicion when assessing patients with movement disorders. Early treatment may reduce morbidity in these patients.

Authors/Disclosures
Rani Priyanka Vasireddy, MBBS PRESENTER	Dr. Vasireddy has nothing to disclose.
Niharika Reddy, MD	Dr. Reddy has nothing to disclose.
Michael A. Witt, MD (University of Kentucky Department of Neurology)	Dr. Witt has nothing to disclose.
Zain Guduru, MD, FAAN (University of Kentucky)	Dr. Guduru has nothing to disclose.

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