Pendular nystagmus and palatal myoclonus from hypertrophic olivary degeneration after hemorrhage of the brain stem

摘要：A 53-year-old man with hypertension developed an acute hemorrhage of brain stem,as seen on CT (Fig.1A,arrow),which resulted in quadriplegia and disturbance of consciousness.Four months later,he complained of reading difficulty because of oscillopsia and could not sit because of equilibrium disturbance.The physical examination revealed pendular nystagmus (two cycles per second) with a predominantly vertical component and some horizontal and torsional eye movements.He also had palatal myoclonus,seen as rhythmic,involuntary contractions of the soft palate and pharyngopalatine arch (one to two cycles per second).T2-weighted magnetic resonance imaging (MRI) showed a symmetrical enlargement of the inferior olivary nuclei with high signal intensity (Fig.1 B,arrowheads).