Holmes tremor and palatal tremor in hypertrophic olivary degeneration: involvement of brainstem
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LETTER TO THE EDITOR
Holmes tremor and palatal tremor in hypertrophic olivary degeneration: involvement of brainstem Xinjie Chen 1 & Lechang Zhan 1
&
Shanshan Ling 1 & Chunye Zheng 2 & Guiyu Lu 3
Received: 6 May 2020 / Accepted: 14 August 2020 # Fondazione Società Italiana di Neurologia 2020
Dear Editor, Hypertrophic olivary degeneration (HOD) is a rare condition characterized by a unique pattern of trans-synaptic degeneration caused by a lesion in the Guillain and Mollaret triangle (GMT) [1]. HOD is usually associated with palatal tremor (PT), and it can give rise to Holmes tremor (HT) by changing the dentate-rubral-olivary pathway (DROP) in rare cases [2, 3]. The coexistence of HT and PT in bilateral HOD is very unusual. We present the case of a patient with bilateral HOD who developed a combination of HT and HOD 5 months following brainstem haemorrhage.
Case presentation A 46-year-old man with a history of pontine haemorrhage was admitted to the hospital with tremors in multiple parts of the body and ataxia, accompanied by mania and anxiety. Based on the neurophysiological examination, we found that the tremors were irregular and coarse, with a frequency of 3–4
Hz; the tremors manifested as head and upper limb tremors in the resting state and could be enhanced by posture and movement. The patient had difficulty closing his eyes and had a loss of the upper visual field in his right eye, accompanied by binocular nystagmus. Obvious PT was observed, accompanied by muscle spasm and dysphagia. According to the Lovett muscle strength classification standard, the muscle strength of the left lower extremity was decreased to level 3, and both proprioceptive sensation and superficial sensation were significantly decreased. The patient could not complete finger-nose, heel-knee-tibia or alternating movement tests and was unable to stand in a balanced position or complete supination-sitting station transfer alone. The patient had a history of conservative treatment for pontine haemorrhage 5 months prior and was discharged without tremor or ataxia. Brain magnetic resonance imaging (MRI) demonstrated a hyperintense and hypertrophic lesion in the bilateral inferior olivary nucleus (ION) consistent with HOD (Fig. 1). After treatment with madopar (0.25 g tid po) and olanzapine (5 mg qd po), the patient recovered a stable mental
Xinjie Chen and Lechang Zhan contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10072-020-04687-w) contains supplementary material, which is available to authorized users. * Lechang Zhan [email protected] Xinjie Chen [email protected]
1
Department of Rehabilitation, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510370, China
2
Department of Neurology, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510120, China
3
Department of Rehabilitation, Zhuhai Hospiatl of the Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Zh
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