gms | German Medical Science

Objective: Kinetic tremor may lead to considerate disability. It is usually secondary to midbrain lesions affecting the dentatothalamic pathway. When patients present with bilateral tremor MR scans usually show also bilateral lesions. The objective of this study is to delineate the pathoanatomical correlate in patients who present with bilateral tremor secondary to a unilateral lesion.

Method: Two women with bilateral kinetic tremor and a unilateral midbrain lesion underwent detailed assessment and neuroimaging studies.

Results: In an 41-year-old woman MR scans demonstrated a tumor extending from the pontomesencephalic junction to the subthalamic area on the right side. Partial resection of the tumor confirmed the diagnosis of glioblastoma. In a 55-year-old patient mesencephalic hemorrhage was secondary to an arteriovenous malformation. The lesions in both patients involved unilaterally the predecussational superior cerebellar peduncle as well as the postdecussational contralateral dentatothalamic pathway.

Conclusions: Bilateral kinetic tremor does not necessarily result from bilateral midbrain lesions. Under very rare circumstances a unilateral lesion may affect both predecussational and postdecussational dentatothalamic pathways.