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NEUROLOGY 2008;71:e30
© 2008 American Academy of Neurology
Resident and Fellow Section

Teaching NeuroImage: Posttraumatic palatal tremor

Formula

Pranshu Sharma, MD, Muneer Eesa, MD, Alexandre Y. Poppe, MD, FRCPC and Mayank Goyal, MD, FRCPC

From the Department of Diagnostic Imaging (P.S., M.E., M.G.) and Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary (A.Y.P.), Foothills Medical Centre, Alberta, Canada.

Address correspondence and reprint requests to Dr. Pranshu Sharma, Department of Diagnostic Imaging, Foothills Medical Centre, 1403-29 St NW Calgary, AB T2N 2T9, Canada pranshu.sharma{at}calgaryhealthregion.ca

A 56-year-old man with head injury, loss of consciousness, and normal head CT 6 weeks prior presented with persistent headache. No neurologic deficit was elicited on examination except for involuntary rhythmic movements of the soft palate, from which he was asymptomatic (video on the Neurology® Web site at www.neurology.org). In particular, he did not complain of ear clicks, and no treatment was offered. MRI showed foci of remote diffuse axonal injury including the left superior cerebellar peduncle (figure, A). The right inferior olivary nucleus was enlarged and hyperintense on T2-weighted images (figure, B).


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  		Figure T2-weighted axial MRIs showing left superior cerebellar peduncle atrophy due to remote diffuse axonal injury (A, arrow) resulting in enlargement and increased signal intensity of the right inferior olivary nucleus suggesting hypertrophic olivary degeneration (B)

 

Symptomatic palatal tremor occurs due to transsynaptic hypertrophic degeneration of the inferior olivary nucleus secondary to lesions involving the contralateral dentate nucleus, superior cerebellar peduncle, or ipsilateral central tegmental tract within the brainstem (Guillain-Mollaret triangle).1

Supplemental data at www.neurology.org

Disclosure: The authors report no disclosures.


   REFERENCE
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 REFERENCE
 

  1. Goyal M, Versnick E, Tuite P, et al. Hypertrophic olivary degeneration: metaanalysis of the temporal evolution of MR findings. Am J Neuroradiol 2000;21:1073–1077.[Abstract/Free Full Text]




This Article
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Right arrow Articles by Goyal, M.
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Right arrow MRI
Right arrow Clinical neurology examination
Right arrow Tremor
Right arrow Myoclonus

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