Holmes’ tremor as a delayed complication of thalamic stroke

We present a 75-year-old man who developed a disabling tremor 1year after a posterolateral thalamic stroke. This tremor had low frequency (3–4Hz), 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 2years 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.
Source: Journal of Clinical Neuroscience - Category: Neuroscience Source Type: research