A 60-year-old female with “movements” in her leg.

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A 60-year-old female with “movements” in her leg.

Resident & Fellow Section Teaching Video NeuroImage

Olszewska DA&Lang AE

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Vignette

A 60-year-old female presented with a 9-month history of palatal tremor and rhythmic, 2-3Hz movements of her right leg (video).

She was treated with trihexyphenidyl 2.5 mg three times a day and amantadine 100 mg three times a day with benefit.

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Video

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Imaging

B D

E G H

A C

F

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Unilateral myorhythmia associated with bilateral olivary hypertrophy in a patient with a midbrain-diencephalic junction cavernous malformation.

A lesion in the upper two arms of the Guillain-Mollaret triangle leads to central tegmental tract damage, deafferentation of the olivary nuclei, and pseudo-

hypertrophy (OH).¹

While the connection with palatal tremor is well-recognized, myorhythmia is rarely reported.

Unilateral myorhythmia with bilateral OH was described in one case.¹

 Isolated myorhythmia was also reported and should be considered as part of the spectrum (brainstem insult/lesion).²