Ann Rehabil Med.  2013 Aug;37(4):591-594. 10.5535/arm.2013.37.4.591.

Holmes Tremor After Brainstem Hemorrhage, Treated With Levodopa

• Woo JH
• Hong BY
• Kim JS
• Moon SH
• Kim SY
• Han HY
• Park DY
• Lim SH

• KMID: 2266619
• DOI: http://doi.org/10.5535/arm.2013.37.4.591

Abstract

Holmes tremor is a rare movement phenomenon, with atypical low-frequency tremor at rest and when changing postures, often related to brainstem pathology. We report a 70-year-old female patient who was presented with dystonic head and upper limb tremor after brainstem hemorrhage. The patient had experienced a sudden onset of left hemiparesis and right facial paralysis. Brain magnetic resonance imaging showed an acute hemorrhage from the brachium pontis through the dorsal midbrain on the right side. Several months later, the patient developed resting tremor of the head and left arm, which was exacerbated by a sitting posture and intentional movement. The tremor showed a regular low-frequency (1-2 Hz) for the bilateral sternocleidomastoid and cervical paraspinal muscles at rest. The patient's symptoms did not respond to propranolol or clonazepam, but gradually improved with levodopa administration. Although various remedies were attempted, overall, the results were poor. We suggest that levodopa might be a useful remedy for Holmes tremor. The curative or relieving effect of the dopaminergic agent in Holmes tremor needs more research.

Keyword

Holmes tremor; Traumatic brain stem hemorrhage; Levodopa

MeSH Terms

Arm
Brain
Brain Stem
Brain Stem Hemorrhage, Traumatic
Clonazepam
Facial Paralysis
Female
Head
Hemorrhage
Humans
Levodopa
Magnetic Resonance Imaging
Mesencephalon
Muscles
Paresis
Posture
Propranolol
Tremor
Upper Extremity
Clonazepam
Levodopa
Propranolol

Figure

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  Fig. 1 Acute hemorrhage (arrow) was seen on sagittal brain T1 magnetic resonance imaging scan, extending from the brachium pontis to the dorsal midbrain.

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  Fig. 2 Initial electromyogram of the right sternocleidomastoid muscle of the neck showed regular, low-frequency (1.1 Hz) contraction (200 µV per division and 500 ms per division).

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