title: Levodopa-responsive Holmes' Tremor Caused by a Single Inflammatory Demyelinating Lesion.
abstract: BACKGROUND
  Holmes' tremor is characterized by a combination of rest, postural, and kinetic tremor that is presumably caused by interruption of cerebello-thalamo-cortical and nigrostriatal pathways. Medical treatment remains unsatisfactory.
  
  
  METHODS
  A 16-year-old girl presented with Holmes' tremor caused by a transient midbrain abnormality on magnetic resonance imaging (MRI). To explore the discrepancy between persistent tremor and resolved MRI changes, we performed dopamine transporter single-photon emission computed tomography (DaT-SPECT) with a 123I-ioflupane that revealed nearly absent DaT binding in the right striatum. Levodopa dramatically improved the tremor.
  
  
  CONCLUSIONS
  This is only the second report of a transient midbrain MRI abnormality disrupting nigrostriatal pathways. The case highlights the sometimes limited sensitivity of morphologic imaging for identifying the functional consequences of tissue damage and confirms that DaT imaging may serve as a predictor for levodopa responsiveness in Holmes' tremor.
authors.affiliation: Department of Neurology, Medical University of Graz, Graz, Austria.
authors.forename: Petra
authors.initials: P
authors.lastname: Katschnig-Winter
authors.affiliation: Department of Neurology, Medical University of Graz, Graz, Austria.
authors.forename: Mariella
authors.initials: M
authors.lastname: Koegl-Wallner
authors.affiliation: Department of Neurology, Medical University of Graz, Graz, Austria.
authors.forename: Tamara
authors.initials: T
authors.lastname: Pendl
authors.affiliation: Department of Neurology, Medical University of Graz, Graz, Austria.
authors.forename: Franz
authors.initials: F
authors.lastname: Fazekas
authors.affiliation: Department of Neurology, Medical University of Graz, Graz, Austria ; Division of Neuroradiology, Department of Radiology, Medical University of Graz, Graz, Austria.
authors.forename: Petra
authors.initials: P
authors.lastname: Schwingenschuh
keywords: Holmes' Tremor; Levodopa responsiveness; abnormal DaT-SPECT; midbrain lesion; remitting MRI abnormalities