Brain Neurorehabil.  2014 Sep;7(2):101-104. 10.12786/bn.2014.7.2.101.

Motor Symptoms in Brain Stem Lesion

Affiliations
  • 1Department of Physical Medicine and Rehabilitation, Hallym University College of Medicine, Korea. ohnsh@hallym.ac.kr

Abstract

Palatal tremor and Kernohan-Woltman notch phenomenon are rare motor symptoms that can show up in patients with lesion in brain stem or cerebellum. Patients with palatal tremor accompany ataxia, internuclear ophthalmoplegia, dysphagia, dysarthria and Kernohan-Woltman notch phenomenon causes ipsilateral motor deficits. Although its rarity, these conditions exhibit unexpected symptoms as well as considerable disability, which can raise etiologic and prognostic concerns for rehabilitation team. These two motor symptoms are discussed in this review.

Keyword

brain stem; motor; palatal tremor; Kernohan-Woltman notch phenomenon

MeSH Terms

Ataxia
Brain Stem*
Cerebellum
Deglutition Disorders
Dysarthria
Humans
Ocular Motility Disorders
Rehabilitation
Tremor

Reference

1. Voogd J, Glickstein M. The anatomy of the cerebellum. Trends Cogn Sci. 1998; 2:307–313.
Article
2. Lapresle J, Hamida MB. The dentato-olivary pathway: somatotopic relationship between the dentate nucleus and the contralateral inferior olive. Arch Neurol. 1970; 22:135–143.
3. Pogorzelski R, Drozdowski W, Rogowski M. Symptomatic palatal myoclonus with ear click after tick-borne meningoencephalitis. Eur Arch Otorhinolaryngol. 2006; 263:711–713.
Article
4. Jacobs L, Newman RP, Bozian D. Disappearing palatal myoclonus. Neurology. 1981; 31:748–748.
Article
5. Litman RS, Hausman SA. Bilateral palatal myoclonus. Laryngoscope. 1982; 92:1187–1189.
6. Samuel M, Torun N, Tuite PJ, Sharpe JA, Lang AE. Progressive ataxia and palatal tremor (PAPT) Clinical and MRI assessment with review of palatal tremors. Brain. 2004; 127:1252–1268.
Article
7. Miley JT, Rodriguez GJ, Hernandez EM, Bundlie SR. Teaching NeuroImage: traumatic internuclear ophthalmoplegia. Neurology. 2008; 70:e3–e4.
Article
8. Drysdale A, Ansell J, Adeley J. Palato-pharyngo-laryngeal myoclonus: an unusual cause of dysphagia and dysarthria. J Laryngol Otol. 1993; 107:746–747.
Article
9. Roy N. Differential diagnosis of muscle tension dysphonia and spasmodic dysphonia. Curr Opin Otolaryngol Head Neck Surg. 2010; 18:165–170.
Article
10. Walsh RA, Gillivan-Murphy P, Murphy C, Colreavy M, O'Rourke K, Lynch T. Bilateral cerebellar stroke presenting with acute dysphonia and late palatal tremor. Mov Disord. 2012; 27:346.
Article
11. Deuschl G, Löhle E, Heinen F, Lücking C. Ear click in palatal tremor Its origin and treatment with botulinum toxin. Neurology. 1991; 41:1677–1677.
Article
12. Penney SE, Bruce IA, Saeed SR. Botulinum toxin is effective and safe for palatal tremor. J Neurol. 2006; 253:857–860.
Article
13. Krause E, Leunig A, Klopstock T, Gürkov R. Treatment of essential palatal myoclonus in a 10-year-old girl with botulinum neurotoxin. Otol Neurotol. 2006; 27:672–675.
14. Yik JH, Seet RC, Pek CH, Lim EC. A woman with progressive ataxia and hemiparesis on the right side: Where's the lesion? CMAJ. 2007; 177:247–248.
Article
15. Kernohan JW, Woltman HW. Incisura of the crus due to contralateral brain tumor. Arch Neurol Psychiatry. 1929; 21:274–287.
Article
16. Zafonte RD, Lee CY. Kernohan-Woltman notch phenomenon: An unusual cause of ipsilateral motor deficit. Arch Phys Med Rehabil. 1997; 78:543–545.
Article
17. Carrasco R, Pascual JM, Navas M, Martínez-Flórez P, Manzanares-Soler R, Sola RG. Kernohan-Woltman notch phenomenon caused by an acute subdural hematoma. J Clin Neurosci. 2009; 16:1628–1163.
Article
18. Mastronardi L, Puzzilli F, Ruggeri A, Guiducci A. Magnetic resonance imaging findings of Kernohan-Woltman notch in acute subdural hematoma. Clin Neurol Neurosurg. 1999; 101:122–124.
Article
19. Moon KS, Lee JK, Joo SP, Kim TS, Jung S, Kim JH, Kim SH, Kang SS. Kernohan's notch phenomenon in chronic subdural hematoma: MRI findings. J Clin Neurosci. 2007; 14:989–992.
Article
20. Yoo W, Kim D, Kwon Y, Jang S. Kernohan's notch phenomenon demonstrated by diffusion tensor imaging and transcranial magnetic stimulation. J Neurol Neurosurg Psychiatry. 2008; 79:1295–1297.
Article
21. Mori S, Oishi K, Faria AV. White matter atlases based on diffusion tensor imaging. Curr Opin Neurol. 2009; 22:362.
Article
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