J Cerebrovasc Endovasc Neurosurg.  2014 Sep;16(3):299-302. 10.7461/jcen.2014.16.3.299.

Holmes' Tremor Associated with Bilateral Hypertrophic Olivary Degeneration Following Brain Stem Hemorrhage: A Case Report

• Kim MK
• Cho BM
• Park SH
• Yoon DY

• KMID: 1963171
• DOI: http://doi.org/10.7461/jcen.2014.16.3.299

Abstract

Holmes' tremor is a condition characterized by a mixture of postural, rest, and action tremors due to midbrain lesions in the vicinity of the red nucleus. Hypertrophic olivary degeneration (HOD) is a rare type of neuronal degeneration involving the dento-rubro-olivary pathway and may present clinically as Holmes tremor. We report on a 59-year-old female patient who developed Holmes tremor in association with bilateral HOD, following brain stem hemorrhage.

Keyword

Tremor; Red nucleus; Olivary Nucleus; Midbrain

MeSH Terms

Brain Stem*
Female
Hemorrhage*
Humans
Mesencephalon
Middle Aged
Neurons
Olivary Nucleus
Red Nucleus
Tremor*

Figure

• 

  Fig. 1 A 59-year-old woman with bilateral hypertrophic olivary degeneration following brain stem hemorrhage. (A) Pre-contrast computed tomography scan shows acute hemorrhage (arrow) in the bilateral pons. (B) Axial T2-weighted magnetic resonance (MR) image obtained seven months after ictus shows very low signal intensity hemosiderin (arrows) in the pons, associated with marked pontine atrophy. (C) Axial T2-weighted MR image at the level of medulla oblongata shows hyperintensity and hypertrophy of the bilateral inferior olivary nuclei (arrows). (D) Axial T1-weighted MR image, obtained at the same level as C, shows iso-signal intensity of the bilateral inferior olivary nuclei (arrows). (E) These lesions are not enhanced after administration of gadolinium contrast material.

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