titubation

Titubation is a slow, low-amplitude tremor characterized by rhythmic nodding of the head or rocking of the trunk. It is typically a sign of cerebellar dysfunction, especially involving midline structures such as the cerebellar vermis, though brainstem involvement can also contribute. Titubation may be present at rest or more evident with upright posture or movement, and it can occur alongside other cerebellar signs.

Clinical features commonly include trunk titubation (tremor of the torso) and head titubation (head nodding). The movements are usually slow and may be irregular. Titubation is often accompanied by truncal and limb ataxia, dysarthria, and nystagmus, reflecting broader cerebellar involvement.

Causes include lesions or degenerative processes affecting the cerebellar vermis or adjacent pathways. Conditions linked to titubation include stroke, tumors, multiple sclerosis, spinocerebellar ataxias, and progressive neurodegenerative syndromes such as multiple system atrophy or progressive supranuclear palsy. Metabolic, toxic, or congenital cerebellar abnormalities can also contribute. Medication effects are possible but titubation is most strongly associated with structural cerebellar disease.

Diagnosis and management: Evaluation relies on a thorough neurological examination and brain imaging, with MRI preferred to identify cerebellar pathology. Management targets the underlying condition and may involve physical and occupational therapy, balance and gait training, and treatment of associated ataxia. In selected cases, botulinum toxin injections to neck muscles can reduce cervical titubation. Pharmacologic options are limited and evidence varies. Prognosis depends on the underlying disorder and may range from stable to progressive.