title: Natural course of combined limb and palatal tremor caused by cerebellar-brain stem infarction.
abstract: After infarction of the left superior cerebellar peduncle and dentate nucleus, a patient developed tremor of the left upper limb beginning on the twelfth day followed by palatal tremor appearing 10 months after infarction. Surface electromyogram revealed a difference in the frequency of the tremor in the upper limb and soft palate. When the palatal tremor appeared, brain magnetic resonance T2-weighted images revealed high signal intensity of the contralateral, right inferior olivary nucleus. Subsequently, when the amplitude of palatal tremor became less severe, the high olivary signal intensity subsided whereas the hypertrophy of the nucleus remained. This patient provides useful information on the pathogenesis of skeletal and palatal tremor with brain stem or cerebellar lesions based on the differences in the onset and frequency of tremors and morphologic changes in the inferior olive.
authors.affiliation: Second Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki City, Kanagawa, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Yanagisawa
authors.forename: H
authors.initials: H
authors.lastname: Sugihara
authors.forename: K
authors.initials: K
authors.lastname: Shibahara
authors.forename: T
authors.initials: T
authors.lastname: Kamo
authors.forename: K
authors.initials: K
authors.lastname: Fujisawa
authors.forename: M
authors.initials: M
authors.lastname: Murayama
mesh_terms: D001132:Arm / Q000503:physiopathology*; D020520:Brain Infarction / Q000150:complications* / Q000473:pathology; D001933:Brain Stem / Q000098:blood supply* / Q000473:pathology; D002531:Cerebellum / Q000098:blood supply* / Q000473:pathology; D018450:Disease Progression; D006801:Humans; D006984:Hypertrophy / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009847:Olivary Nucleus / Q000473:pathology; D010159:Palate / Q000503:physiopathology*; D012720:Severity of Illness Index; D014202:Tremor / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology*