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Images in Neurology
September 2013

A Rare Presentation of Hypertrophic Olivary Degeneration Secondary to Primary Central Nervous System Lymphoma

Author Affiliations
  • 1University of Massachusetts Medical School, Worcester

Copyright 2013 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA Neurol. 2013;70(9):1192-1193. doi:10.1001/2013.jamaneurol.218

A 71-year-old man presented with a 2-week history of nausea, vomiting, unsteady gait, and diplopia. Magnetic resonance imaging of the brain revealed a gadolinium-enhanced lesion involving the superior vermis and the right middle cerebellar peduncle (Figure 1A and B). A biopsy was consistent with a high-grade B-cell lymphoma (Figure 2). Three months later, the patient was readmitted with difficulty walking, diplopia, loss of coordination, and slurring of speech. On examination, he had scanning dysarthric speech and palatal myoclonus (Video). An eye examination revealed right-sided gaze-evoked nystagmus and bilateral vertical pendular nystagmus in the primary position. Significant truncal ataxia was present. There was evidence of appendicular ataxia with dysmetria more noticeable on the right. Tone was more increased on the right than on the left, with spasticity mostly affecting the lower extremities.