Session Information
Date: Wednesday, June 7, 2017
Session Title: Neuroimaging (Non-PD)
Session Time: 1:15pm-2:45pm
Location: Exhibit Hall C
Objective: To describe the neuroanatomical correlations of unilateral versus bilateral hypertrophic olivary degeneration (HOD) in three patients diagnosed with Holmes’ (rubral) tremor, secondary to midbrain lesions.
Background: The pathogenesis of HOD is related to a unique process of transynaptic degeneration whereby neurons loss is succeeded by reactive gliosis causing hypertrophy of the affected structure rather than atrophy. Bilateral HOD is unique in that it can result from a single unilateral lesion within the triangle of Guillian and Mollaret, compromising of connections between the inferior olivary nucleus, ipsilateral red nucleus and contralateral dentate nucleus.
Lesions involving the central tegmental tract result in ipsilateral HOD, whilst lesions of the dentate nucleus and superior cerebellar peduncle cause contralateral HOD. Bilateral HOD has been reported in lesions involving both the central tegmental tract and superior cerebellar peduncle.
Methods: 3 patients were identified with Holmes’ tremor associated with olivary degeneration on MRI imaging.
A 59 year old female developed a left sided Holmes’ tremor following a right sided tegmentum plate haemorrhage. Her MRI identified bilateral HOD associated with a small haemorrhagic lesion in the pons involving the right red nucleus.
A 16 year old female presented with a left sided Holmes’ tremor after a haemorrhage following stereotactic surgery for a right midbrain AVM. MRI demonstrated a haemorrhagic cavity involving the right red nucleus and encephalomalacic changes in the right midbrain. Bilateral olivary degeneration is present.
A 47 year old gentleman who presented with a Holmes’ tremor affecting the right arm and leg. His imaging showed a large left midbrain cavernoma for which he underwent a partial excision. Ipsilateral olivary degeneration was evident. He responded well to left VIM DBS.
Results: MR imaging of the 3 patients demonstrated the presence of HOD secondary to a lesion within the Triangle of Guillian-Mollaret. The lesion location within this circuit determines the development of HOD and whether it is unilateral or bilateral.
Conclusions: In patients with Holmes’ tremor unilateral HOD is associated with central tegmental tract lesions interrupting the ipsilateral rubro-olivary pathways whilst bilateral HOD is associated with lesions involving the above pathway as well as the superior cerebellar tract connecting with the contralateral dentate nucleus.
References: Bouz P, Woods ROJ, Woods KRM. The Pathophysiological Basis for Hypertrophic Olivary Degeneration (HOD) Following Brainstem Insult. JSM Neurosurg Spine. 2013;1(1):1004-7
Kim MK, Cho BM, Park S-H, Yoon DY. Holmes’ Tremor Associated with Bilateral Hypertrophic Olivary Degeneration Following Brainstem Haemorrhage: A Case Report. J Cerebrovasc Endovasc Neurosurg. 2014;16(3):299-302
To cite this abstract in AMA style:
R. Ellis, S. Biswas, R. Pullicino, J. Panicker, B. Hammersley, J. Farah, S. Alusi. Holmes’ tremor and olivary hypertrophy: lessons from this neuroanatomical correlation [abstract]. Mov Disord. 2017; 32 (suppl 2). https://www.mdsabstracts.org/abstract/holmes-tremor-and-olivary-hypertrophy-lessons-from-this-neuroanatomical-correlation/. Accessed May 13, 2025.« Back to 2017 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/holmes-tremor-and-olivary-hypertrophy-lessons-from-this-neuroanatomical-correlation/