gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Unilateral Homes tremor due to an ischemic midbrain lesion associated with hydrocephalus and clearly responsive to CSF drainage

Einseitiger Holmes-Tremor verursacht durch eine ischämische Mittehirnläsion, kombiniert mit einem Hydrozephalus spricht eindeutig auf eine Liquorentlastung an

Meeting Abstract

  • corresponding author Frank Hertel - Klinik für Neurochirurgie, Brüderkrankenhaus Trier, Trier
  • M. Züchner - Klinik für Neurochirurgie, Brüderkrankenhaus Trier, Trier
  • M. Bettag - Klinik für Neurochirurgie, Brüderkrankenhaus Trier, Trier
  • E. Erken - Klinik für Neurologie, Städtisches Klinikum, Idar Oberstein
  • M. Schmitt - Klinik für Nuklearmedizin, Brüderkrankenhaus Trier, Trier
  • S. Libri - Klinik für Neurologie, Brüderkrankenhaus Trier, Trier

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocP 12.125

The electronic version of this article is the complete one and can be found online at:

Published: April 23, 2004

© 2004 Hertel et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.




To describe a case of a 58-year-old man with a sudden onset of unilateral tremor and headaches. The patient was severely handicapped by the tremor which had resting, postural and intention components.


The patient was extensively clinically and electrophysiologically examined. Furthermore, CCT, MRI, MRI-perfusion, DAT-scan and IBZM-SPECT was done. The patient had a temporary CSF drainage, then a ventriculoperitoneal shunt and after 6 months a stereotactic implantation of an electrode in the contralateral VIM.


CCT showed an enlargement of all cerebral ventricels. In MRI, a small ischemic lesion between the red nucleus and substantia nigra could be seen. There was no change of cerebral perfusion measurement detectable in perfusion sensitive MRI. In DAT scan and IBZM-SPECT, Parkinson´s disease and MSA could be ruled out as a cause for the tremor. In EMG, the tremor could be described as a 4-5 HZ resting, intention and postural agonist-antagonist tremor. After temporary CSF drainage, the tremor was completely suppressed for several days. After VP-shunting, it was suppressed for 6 months without any additional medication. Afterwards, the tremor came back and had to be treated by VIM stimulation, which suppressed the tremor completely and permanently.


We describe a rare case of an association of a Homes tremor with hydrocephalus. The tremor, as well as the therapeutic effects are well documented (Videos are available). Other causes for the tremor, such as Parkinson´s disease or MSA could be ruled out. This case is very interesting and different pathophysiological aspects are to be discussed.