A Patient with Bilateral Tremors Secondary to a Unilateral Brainstem Lesion: The Utility of Mollaret′s Triangle

Tran AT, Deep A, Moguel-Cobos G and Lieberman A

Department of Neurology, U.S. Department of Veterans Affairs, USA
Department of Neurology, Barrow Neurological Institute, USA

^*Correspondance to: Tran AT 

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Abstract:

A unilateral tremor developed in a patient’s left arm after a right midbrain hemorrhage. Thirteen years later, a re-bleed into that same area caused an additional right arm tremor. He now had bilateral arm tremors from a unilateral midbrain hemorrhage. The tremor was refractory to medications (propranolol, primidone, clonazepam, and levodopa). MRI brain showed bilateral hypertrophic olivary degeneration (HOD) from this unilateral midbrain hemorrhage. Although HOD has been associated with unilateral midbrain “rubral” tremor, it has not been described for bilateral intentional tremor. This case report illustrates how overlapping Mollaret’s triangles can explain this patient’s bilateral clinical findings

Keywords:

Intentional tremor; Mollaret’s triangle; Midbrain tremor; Rubral tremor; Midbrain hemorrhage; Hypertrophic olivary degeneration

Cite the Article:

Tran AT, Deep A, Moguel-Cobos G, Lieberman A. A Patient with Bilateral Tremors Secondary to a Unilateral Brainstem Lesion: The Utility of Mollaret′s Triangle. Ann Clin Case Rep. 2016; 1: 1044.