Article
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
Search Medline for
Authors
Published: | April 23, 2004 |
---|
Outline
Text
Objective
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.
Methods
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.
Results
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.
Conclusions
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.