case_images: PMC11736888_01
case_images: Extraocular movements: pendular nystagmus, vertical sopranuclear gaze limitation, bilateral restriction in abduction of both eyes (more severe on left), skew deviation with left hypotropia, saccadic pursuit.. Oculo-palatal tremor.
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case_images: PMC11736888_01_.jpg
case_images: mdc314247-fig-0003
case_images: MRI confirmed bilateral HOD and persistent hemosiderin deposit affecting midbrain, pons, and superior cerebellar peduncle, without significant cerebellar atrophy (Fig. 1).
case_images: Magnetic resonance imaging findings. (A) Axial T2-weighted bilateral hypertrophic olivary degeneration (arrows). (B,C) Susceptibility weighted imaging sequence and coronal T2-weighted showed hemosiderin accumulation in right midbrain, superior cerebellar peduncle and pons. (D) Sagittal fluid attenuated inversion recovery (FLAIR) showed clear involvement of Guillan-Mollaret triangle but no signs of cerebellar atrophy.
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case_images: PMC11736888_01_MDC3-12-89-g002.jpg
case_images: mdc314247-fig-0001
case_images: Electromyography (EMG) of laryngeal muscles showed a 2 Hz pseudo-rhythmic activation of thyroarytenoid and cricoarytenoid muscles, indicating larynx involvement (Fig. 2).