title: Bilateral Hypertrophic Olivary Degeneration and Holmes Tremor without Palatal Tremor: An Unusual Association.
abstract: BACKGROUND
  Lesions in the Guillain-Mollaret triangle or dentate-rubro-olivary pathway may lead to hypertrophic olivary degeneration (HOD), a secondary trans-synaptic degeneration of the inferior olivary nucleus. HOD is usually associated with palatal tremor and rarely with Holmes tremor. Bilateral HOD is a very unusual condition and very few cases are reported.
  
  
  METHODS
  We report here two cases of bilateral HOD after two different vascular lesions located at the decussation of superior cerebellar peduncles, thus impairing both central tegmental tracts and interrupting bilaterally the dentate-rubral-olivary pathway. Interestingly, both developed bilateral Holmes tremor but not palatal tremor.
  
  
  CONCLUSIONS
  Lesions in some of the components in the Guillain-Mollaret triangle may develop Holmes tremor with HOD and without palatal tremor. Magnetic resonance imaging is an invaluable tool in these cases. Better understanding of the pathways in this loop is needed.
authors.affiliation: Departamento de Enfermedades Neurodegenerativas, Instituto Nacional de Ciencias Neurológicas, Lima, Peru.
authors.forename: Carlos
authors.initials: C
authors.lastname: Cosentino
authors.affiliation: Departamento de Enfermedades Neurodegenerativas, Instituto Nacional de Ciencias Neurológicas, Lima, Peru.
authors.forename: Miriam
authors.initials: M
authors.lastname: Velez
authors.affiliation: Departamento de Enfermedades Neurodegenerativas, Instituto Nacional de Ciencias Neurológicas, Lima, Peru.
authors.forename: Yesenia
authors.initials: Y
authors.lastname: Nuñez
authors.affiliation: Departamento de Enfermedades Neurodegenerativas, Instituto Nacional de Ciencias Neurológicas, Lima, Peru.
authors.forename: Henry
authors.initials: H
authors.lastname: Palomino
authors.affiliation: Departamento de Enfermedades Neurodegenerativas, Instituto Nacional de Ciencias Neurológicas, Lima, Peru.
authors.forename: Darko
authors.initials: D
authors.lastname: Quispe
authors.affiliation: Departamento de Enfermedades Neurodegenerativas, Instituto Nacional de Ciencias Neurológicas, Lima, Peru.
authors.forename: Martha
authors.initials: M
authors.lastname: Flores
authors.affiliation: Departamento de Enfermedades Neurodegenerativas, Instituto Nacional de Ciencias Neurológicas, Lima, Peru.
authors.forename: Luis
authors.initials: L
authors.lastname: Torres
keywords: Guillain–Mollaret triangle; Holmes tremor; olivary nucleus