Background: Hypertrophic olivary degeneration (HOD) is a rare phenomenon, probably related to transsynaptic degeneration of the inferior olivary nucleus. It usually occurs as a response to primary injury of dento-rubro-olivary pathways.Case report: A young man developed Holmes' tremor 7 months after a cavernous malformation bleed in the midbrain. Typical findings of HOD were observed in the magnetic resonance images: bilateral and asymmetric hypertrophy of the olivary nucleus with slight hypersignal in T2-weighted images. Because of the striking disability related to drug-resistant tremor, the patient underwent stereotactic thalamotomy (nucleus ventralis intermedius of the thalamus/zona incerta) with pronounced functional improvement over time.Discussion: Disruption of circuits in the Guillain-Mollaret triangle classically results in palatal myoclonus, however midbrain (Holmes') tremor can also occur, as we now describe.
This study was significant because it reported on the use of laryngeal electromyography in a large number of patients with PD and vocal complaints grouped according to PD severity. The patterns observed suggest that laryngeal electromyography is a valuable diagnostic tool for PD even at early phases of the disease.
Neste capítulo são abordados o histórico do tratamento cirúrgico da doença de Parkinson, as principais indicações e contra-indicações dos diversos tipos de procedimentos,considerando as cirurgias clássicas de neuroablação (palidotomias e talamotomias), modernas técnicas de neuroestimulação cerebral profunda e, mais recentemente, perspectivas de abordagens relacionadas a transplantes neurais, particularmente protocolos atuais de transplante de células tronco.
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