Hypertrophic Olivary Degeneration and Holmes’ Tremor Secondary to Bleeding of Cavernous Malformation in the Midbrain

Tremor and Other Hyperkinetic Movements

article

Djalma F. S. Menéndez¹  Rubens G. Cury²  Egberto R. Barbosa²  Manoel J. Teixeira³  Erich T. Fonoff³ 

[1] Division of Functional Neurosurgery of the Institute of Psychiatry of the Hospital das Clinicas of the University of São Paulo;Abnormal Movements Unit of the Hospital das Clinicas of the University of São Paulo;Discipline of Neurosurgery of the São Paulo University Medical School

关键词: Olivary nucleus;    pathology;    tremor;    etiology;    magnetic resonance imaging;    central nervous system vascular malformations;    stereotaxic surgery;   

DOI  :  10.5334/tohm.210

学科分类：社会科学、人文和艺术（综合）

来源: Ubiquity Press

【 摘 要 】

Background: Hypertrophic olivary degeneration (HOD) is a rare phenomenon, probably related to transsynaptic degeneration of the inferior olivary nucleus. It usually occurs as a response to primary injury of dento-rubro-olivary pathways. Case report: A young man developed Holmes’ tremor 7 months after a cavernous malformation bleed in the midbrain. Typical findings of HOD were observed in the magnetic resonance images: bilateral and asymmetric hypertrophy of the olivary nucleus with slight hypersignal in T2-weighted images. Because of the striking disability related to drug-resistant tremor, the patient underwent stereotactic thalamotomy (nucleus ventralis intermedius of the thalamus/zona incerta) with pronounced functional improvement over time. Discussion: Disruption of circuits in the Guillain–Mollaret triangle classically results in palatal myoclonus, however midbrain (Holmes’) tremor can also occur, as we now describe.

【 授权许可】

CC BY