Hypertrophic olivary degeneration and palatal myoclonus from a Streptococcus intermedius infection of the brain: illustrative case.
J Neurosurg Case Lessons
; 3(24): CASE2265, 2022 Jun 13.
Article
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| MEDLINE
| ID: mdl-35733632
BACKGROUND: Hypertrophic olivary degeneration (HOD) is a rare condition that can occur after disruption of the Guillain-Mollaret triangle. Clinically, HOD can present with palatal myoclonus with or without oculopalatal tremor, which sometimes results in symptomatic dysphagia and/or speech abnormalities. This condition is commonly associated with vascular lesions, with only three prior reported cases of HOD resulting from intracranial abscess. OBSERVATIONS: An otherwise healthy patient developed multiple intracranial abscesses. Biopsy showed gram-positive cocci; however, culture findings were negative. Polymerase chain reaction (PCR) identified Streptococcus intermedius. The patient demonstrated palatal myoclonus and vertical nystagmus, which resulted in persistent mild dysphagia and altered speech intonation. After appropriate antimicrobial therapy with resolution of the enhancing lesions, symptoms persisted. Follow-up imaging demonstrated progressive hypertrophy of the right olive with persistent disruption of the right-sided rubro-olivo fiber pathways. LESSONS: Although HOD classically occurs after vascular insult, it can also be seen as a postinfectious sequela. Despite eradication of the infection, palatal myoclonus and oculopalatal tremor may have a persistent impact on quality of life due to impaired speech and swallowing. This case emphasizes the utility of universal PCR in detecting fastidious organisms as well as diffusion tensor imaging for characterization of disrupted fiber pathways.
CTT = central tegmental tract; GMT = Guillain-Mollaret triangle; Guillain-Mollaret triangle; HOD = hypertrophic olivary degeneration; MRI = magnetic resonance imaging; OPT = oculopalatal tremor; PCR = polymerase chain reaction; PT = palatal tremor; SCP = superior cerebellar peduncle; Streptococcus intermedius; brainstem; diffusion tensor imaging; hypertrophic olivary degeneration; palatal myoclonus
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1
Colección:
01-internacional
Base de datos:
MEDLINE
Tipo de estudio:
Prognostic_studies
Aspecto:
Patient_preference
Idioma:
En
Revista:
J Neurosurg Case Lessons
Año:
2022
Tipo del documento:
Article
Pais de publicación:
Estados Unidos