Midbrain tremor and hypertrophic olivary degeneration after pontine hemorrhage

Gordon M G Shepherd, Erik Tauböll*, Sören Jacob Bakke, Rolf Nyberg-Hansen

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

59 Scopus citations


A severe rest tremor arose in a patient's right arm 9 months after a pontine tegmental hemorrhage. Magnetic resonance studies at 4 and 10 months showed residual hemosiderin in the ppns and increasing hypertrophic olivary degeneration (HOD) affecting primarily the left olive. The tremor was refractory to pharmacotherapy (clonazepam, propranolol, and levodopa), but was reduced after implantation of a thalamic stimulator device. Although pontine hemorrhage is among several common causes of HOD, it has not previously been appreciated as a cause of midbrain ('rubral') tremor. A disynaptic dentatorubroolivary tract associated with tremor and a monosynaptic dentatoolivary tract associated with HOD may both be components of the rubroolivocerebeliorubral loop implicated in midbrain tremor. Their proximity makes the combination of tremor and HOD after pontine tegmental damage plausible and even likely.

Original languageEnglish (US)
Pages (from-to)432-437
Number of pages6
JournalMovement Disorders
Issue number3
StatePublished - Jun 3 1997


  • Dentatoolivary tract
  • Dentatorubroolivary tract
  • Oivary hypertrophy
  • Pontine hemorrhage
  • Rubral tremor
  • Thalamic stimulation

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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