Oculopalatal tremor (OPT) usually occurs several months after an acute lesion (typically a stroke) in the brainstem or cerebellum. Symptoms can consist of a rhythmic clicking sound in one or both ears (due to a continuous involuntary tremor of the soft palate) and a disturbance of vision or equilibrium (due to a continuous involuntary movement of the eyes). Brain MRI shows abnormal signal in the inferior olive. Treatment with gabapentin is usually well tolerated and sometimes helpful.