title: Holmes' tremor as a delayed complication of thalamic stroke.
abstract: Movement disorders are not commonly associated with stroke. Accordingly, thalamic strokes have rarely been associated with tremor, pseudo-athetosis and dystonic postures. We present a 75-year-old man who developed a disabling tremor 1 year after a posterolateral thalamic stroke. This tremor had low frequency (3-4 Hz), did not disappear on focus and was exacerbated by maintaining a static posture and on target pursuit, which made it very difficult to perform basic functions. MRI demonstrated an old ischemic lesion at the left posterolateral thalamus. Treatment with levodopa led to symptom control. Lesions in the midbrain, cerebellum and thalamus may cause Holmes' tremor. Delayed onset of symptoms is usually seen, sometimes appearing 2 years after the original injury. This may be due to maturation of a complex neuronal network, leading to slow dopaminergic denervation. Further studies are needed to improve our understanding of this unique disconnection syndrome.
authors.affiliation: Department of Neurology, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenida Ipiranga 6690, CEP: 90610-000, Brazil. Electronic address: walvesm.br@gmail.com.
authors.forename: William Alves
authors.initials: WA
authors.lastname: Martins
authors.affiliation: Department of Neurology, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenida Ipiranga 6690, CEP: 90610-000, Brazil.
authors.forename: Luiz Carlos Porcello
authors.initials: LC
authors.lastname: Marrone
authors.affiliation: Department of Neurology, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenida Ipiranga 6690, CEP: 90610-000, Brazil.
authors.forename: Helena
authors.initials: H
authors.lastname: Fussiger
authors.affiliation: Department of Neurology, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenida Ipiranga 6690, CEP: 90610-000, Brazil.
authors.forename: Viviane Maria
authors.initials: VM
authors.lastname: Vedana
authors.affiliation: Department of Neurology, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenida Ipiranga 6690, CEP: 90610-000, Brazil.
authors.forename: Rafael do Amaral
authors.initials: Rdo A
authors.lastname: Cristovam
authors.affiliation: Department of Neurology, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenida Ipiranga 6690, CEP: 90610-000, Brazil.
authors.forename: Marjorye Z
authors.initials: MZ
authors.lastname: Taietti
authors.affiliation: Department of Neurology, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenida Ipiranga 6690, CEP: 90610-000, Brazil; Internal Medicine, Division of Neurology, Faculty of Medicine, PUCRS, Porto Alegre, Brazil.
authors.forename: Antonio Carlos Huf
authors.initials: AC
authors.lastname: Marrone
mesh_terms: D000368:Aged; D015259:Dopamine Agents / Q000627:therapeutic use; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging / Q000009:adverse effects; D008297:Male; D020521:Stroke / Q000150:complications*; D013788:Thalamus / Q000473:pathology*; D014202:Tremor / Q000188:drug therapy / Q000209:etiology*
chemical_list: D015259:Dopamine Agents; D007980:Levodopa
keywords: Holmes’ tremor; Movement disorders; Symptomatic tremor; Thalamic stroke; Thalamic tremor; Ventral posterolateral nucleus