A 60‑year‑old hypertensive woman with a history of right hemiparesis presented with clicking sounds in the ear, progressive dysphagia, and gait disturbance. Neurological examination revealed palatal myoclonus and ataxia. MRI demonstrated white matter hyperintensities, a chronic small paraventricular infarct in the left cerebral hemisphere, and bilateral hyperintense lesions involving the bulbar olivary nuclei. The latter is consistent with hypertrophic olivary degeneration, a known sequelae of cerebral infarcts.
This case illustrates the delayed injury to the Guillain Mollaret triangle, manifesting as rhythmic palatal movements and impaired coordination. Recognition of this syndrome is essential for accurate diagnosis and for distinguishing it from other causes of dysphagia and movement disorders.
