Unilateral Holmes tremor, clearly responsive to cerebrospinal fluid release, in a patient with an ischemic midbrain lesion and associated chronic hydrocephalic ventricle enlargement. Case report.
The authors describe a 58-year-old man with sudden onset of a unilateral tremor caused by a midbrain lesion that affected the substantia nigra and the cerebellothalamic pathway. There were also clinical and neuroimaging signs of a communicating chronic hydrocephalus. The patient was severely handicapped by this tremor, which was a typical Holmes tremor with rest, posture, and intention components. Parkinson disease or multiple-system atrophy as causes for the tremor could be ruled out by DaTSCAN and 123I iodobenzamide and single-photon emission computerized tomography (SPECT), respectively. The tremor was completely supressed by temporary and permanent cerebrospinal fluid release after ventriculoperitoneal shunt placement, without any additional medication, for a period of 6 months. Afterward, the tremor returned, and the patient had to be treated by a stereotactic electrode implantation in the contralateral ventralis intermedius nucleus, which led to complete tremor suppression during the 1.5-year follow-up period. In this case report, the authors present the clinical description and the electrophysiological, SPECT, and magnetic resonance imaging data of a rare combination of symptoms and their surgical treatment.
Department of Neurosurgery, Bruederkrankenhaus Trier, Germany. f.hertel@bk-trier.de
Frank
F
Hertel
Mark
M
Züchner
Christian
C
Decker
Edward
E
Erken
Stefani
S
Libri
Marion
M
Schmitt
Martin
M
Bettag
D002545:Brain Ischemia / Q000150:complications*; D002552:Cerebral Ventricles / Q000473:pathology*; D004594:Electrophysiology; D006801:Humans; D006849:Hydrocephalus / Q000150:complications* / Q000209:etiology* / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D014202:Tremor / Q000209:etiology*; D017287:Ventriculoperitoneal Shunt