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jvvaerenbergh71
05-23-2003, 12:35 AM
Dear everyone,





I would like to start a discussion on myorhythmia caused by a brain stem
stroke.



The MRI of the patient shows a hemorrhagic pontine infarct. In the
beginning there was left hemi paresis with a cerebellar syndrome, a n.
abducens and facial paresis with dysarthria.



There was a quite fast recovery, but 4 months after the insult a
disabling rest and action tremor gradually developed in the proximal
left upper limb together with an intractable heavy jerking of the hand
and forearm



For those who are interested some MRI pictures and a short video clip in
DivX (1MB) are available and can be sent.

The EMG shows a contraction rate around 3 Hz.



This myorhythmia is refractory to pharmacotherapy (Clonazepam,
propanolol, levodopa, carbamazepine, tiapride, sodium valproate..) or
other kinds of therapy. Only during sleep the myorhythmia ceases.



I suppose that we have here an interesting case of a kind of 'rubral'
tremor. In some of those cases a hyperthrophic degeneration of the
inferior olive is demonstrable and related to the onset of the
myorhythmia, which reflects a reverberating activity in the
rubroolivocerebellorubral loop, but we don't have a recent MRI. The MRI
was taken a month after the stroke and at a moment the tremor was not as
manifest as it is now.

We are now 9 months post stroke.





My question is:



Who has experience with this kind of 'abnormal movements' or knows more
about it? In every case this condition seems not to be so common or am I
wrong?



A thalamic stimulator can probable help but was seldom tried in this
condition and information is very sparse. The last and probably the most
effective solution is a posteroventral pallidotomy.



The discussion is open



I will publish a list of reaction on Biomch-L





Kind regards





J. Van Vaerenbergh

Center for Movement Analysis and Therapy

R.Reniersstraat 11

B-1090 Brussels



Artevelde Institute for higher education

St lievenspoortstraat 143

B-1090 Gent



jo.vanvaerenbergh@cmat.be





references:



1: Wu JC, Lu CS, Ng SH. Limb myorhythmia in association with hypertrophy
of the inferior olive: report of two cases. Changgeng Yi Xue Za Zhi
2000 Oct;23(10):630-5.

2: Miyagi Y, Shima F, Ishido K, Moriguchi M, Kamikaseda K.
Posteroventral pallidotomy for midbrain tremor after a pontine
hemorrhage. Case report.

J Neurosurg 1999 Nov;91(5):885-8

3: Shepherd GM, Tauboll E, Bakke SJ, Nyberg-Hansen R.. Midbrain tremor
and hypertrophic olivary degeneration after pontine hemorrhage.

Mov Disord 1997 May;12(3):432-7.

4: Iwadate Y, Saeki N, Komiya H, Sunami K, Oka N. [Three cases of
involuntary movements following pontine hemorrhage][Article in Japanese]

No To Shinkei 1988 Sep;40(9):869-74

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