Post-traumatic midbrain tremors

"Rubral" tremor after thalamic haemorrhage

Tremors in association with thalamic haemorrhage have been infrequently reported, and delayed rubral tremor as a complication of such an event is quite rare. We describe a patient with a combined resting-postural-kinetic tremor due a thalamic haemorrhage. Magnetic resonance imaging showed evidence of a subthalamic involvement but failed to reveal any mesencephalic lesion. Five years after the original stroke there was rapid and almost complete suppression of her abnormal movements, probably related to an ischaemic capsular lesion. Involuntary movements, which resemble rubral tremor, can be due to lesions upstream of the rubral and nigral outflow system.

"Rubral" tremor induced by a neuroleptic drug

"Rubral" tremor is a rare movement disorder that occurs typically with midbrain damage. It is defined by its presence at rest, with sustained posture, and with movement. Whether it is a single-tremor disorder or a combination of two distinct tremors is debated. This report chronicles a severe neuroleptic induced "rubral" tremor in a patient who had had a stable posttraumatic ataxia. The dramatic response to benztropine and bromocriptine is illustrated in the videotape.

Treatment of post-traumatic midbrain resting-kinetic tremor with combined levodopa/carbidopa and carbamazepine

A patient with a post-traumatic midbrain haemorrhagic lesion documented by magnetic resonance imaging (MRI) presented with a combined resting-kinetic contralateral upper extremity tremor. The resting tremor component responded to levodopa/carbidopa, while the kinetic component improved with the addition of carbamazepine.