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Midbrain tremor and hypertrophic olivary degeneration after pontine hemorrhage
Author(s) -
Shepherd Gordon M. G.,
Tauböll Erik,
Bakke Sören Jacob,
NybergHansen Rolf
Publication year - 1997
Publication title -
movement disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.352
H-Index - 198
eISSN - 1531-8257
pISSN - 0885-3185
DOI - 10.1002/mds.870120327
Subject(s) - pons , midbrain , inferior olivary nucleus , medicine , essential tremor , red nucleus , intention tremor , neuroscience , anesthesia , psychology , anatomy , physical medicine and rehabilitation , central nervous system , ataxia , nucleus
A severe rest tremor arose in a patient's right arm 9 months after a pontine tegmental hemorrhage. Magnetic resonance studies at 4 and 10 months showed residual hemosiderin in the pons and increasing hypertrophic olivary degeneration (HOD) affecting primarily the left olive. The tremor was refractory to pharmacotherapy (clonazepam, propranolol, and levodopa), but was reduced after implantation of a thalamic stimulator device. Although pontine hemorrhage is among several common causes of HOD, it has not previously been appreciated as a cause of midbrain (“rubral”) tremor. A disynaptic dentatorubroolivary tract associated with tremor and a monosynaptic dentatoolivary tract associated with HOD may both be components of the rubro‐olivocerebellorubral loop implicated in midbrain tremor. Their proximity makes the combination of tremor and HOD after pontine tegmental damage plausible and even likely.