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Adhikari A, Bhattarai AM, Pandit A, Rokaya P, Khadka M, Shahi M, Baiju S, Poudel R. Benedikt syndrome in a 74-year-old hypertensive woman: A case report. Clin Case Rep 2022; 10:e6767. [PMID: 36545564 PMCID: PMC9764039 DOI: 10.1002/ccr3.6767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 11/19/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Benedikt syndrome is a rare neurological disorder of the midbrain. Herein, we present a case of Benedikt syndrome, who presented with left-sided body weakness, right oculomotor nerve palsy, cerebellar ataxia, and Holmes tremor in the left upper limb following midbrain infarction. She was treated with aspirin, clopidogrel, and amiodarone.
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Affiliation(s)
| | | | - Ayushma Pandit
- Nepalese Army Institute of Health SciencesKathmanduNepal
| | - Pooja Rokaya
- Nepalese Army Institute of Health SciencesKathmanduNepal
| | - Manoj Khadka
- Nepalese Army Institute of Health SciencesKathmanduNepal
| | | | - Swastika Baiju
- Nepalese Army Institute of Health SciencesKathmanduNepal
| | - Raju Poudel
- Department of NeurologyGrande International HospitalKathmanduNepal
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Ueda M, Tsunogae M, Saito H, Suzuki T, Ota T. Delayed Hemiparkinsonism Associated with Kernohan's Notch in a Patient with a Ruptured Arteriovenous Malformation. Intern Med 2021; 60:309-313. [PMID: 32963161 PMCID: PMC7872802 DOI: 10.2169/internalmedicine.5621-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A 24-year-old female patient was admitted for a right frontal intracranial hematoma with an uncal herniation due to a ruptured arteriovenous malformation and therefore underwent emergency surgery. Neuroimaging revealed left-sided midbrain notching against the tentorium, indicating Kernohan's notch phenomenon. She denied experiencing any short-term neurological deficits but right-sided delayed hemiparkinsonism developed 18 months later. Dopamine transporter tracer uptake was severely reduced in the left striatum, suggesting nigrostriatal degeneration secondary to Kernohan's notch. Uncal herniations are potentially fatal, but surgery can save the patient's life and improve the functional outcomes. Clinicians should therefore be aware of delayed hemiparkinsonism as a rare complication of Kernohan's notch phenomenon.
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Affiliation(s)
- Masayuki Ueda
- Department of Neurology and Stroke Medicine, Tokyo Metropolitan Tama Medical Center, Japan
| | - Marie Tsunogae
- Department of Neurology and Stroke Medicine, Tokyo Metropolitan Tama Medical Center, Japan
| | - Hiroshi Saito
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Japan
| | - Takeya Suzuki
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Japan
| | - Takahiro Ota
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Japan
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Suri R, Rodriguez-Porcel F, Donohue K, Jesse E, Lovera L, Dwivedi AK, Espay AJ. Post-stroke Movement Disorders: The Clinical, Neuroanatomic, and Demographic Portrait of 284 Published Cases. J Stroke Cerebrovasc Dis 2018; 27:2388-2397. [PMID: 29793802 DOI: 10.1016/j.jstrokecerebrovasdis.2018.04.028] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/07/2018] [Accepted: 04/23/2018] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Abnormal movements are a relatively uncommon complication of strokes. Besides the known correlation between stroke location and certain movement disorders, there remain uncertainties about the collective effects of age and stroke mechanism on phenomenology, onset latency, and outcome of abnormal movements. MATERIALS AND METHODS We systematically reviewed all published cases and case series with adequate clinical-imaging correlations. A total of 284 cases were analyzed to evaluate the distribution of different movement disorders and their association with important cofactors. RESULTS Posterolateral thalamus was the most common region affected (22.5%) and dystonia the most commonly reported movement disorder (23.2%). The most common disorders were parkinsonism (17.4%) and chorea (17.4%) after ischemic strokes and dystonia (45.5%) and tremor (19.7%) after hemorrhagic strokes. Strokes in the caudate and putamen were complicated by dystonia in one third of the cases; strokes in the globus pallidus were followed by parkinsonism in nearly 40%. Chorea was the earliest poststroke movement disorder, appearing within hours, whereas dystonia and tremor manifested several months after stroke. Hemorrhagic strokes were responsible for most delayed-onset movement disorders (>6 months) and were particularly overrepresented among younger individuals affected by dystonia. CONCLUSIONS This evidence-mapping portrait of poststroke movement disorders will require validation or correction based on a prospective epidemiologic study. We hypothesize that selective network vulnerability and resilience may explain the differences observed in movement phenomenology and outcomes after stroke.
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Affiliation(s)
- Ritika Suri
- James J. and Joan A. Gardner Center for Parkinson Disease and Movement Disorders, Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio
| | | | - Kelly Donohue
- James J. and Joan A. Gardner Center for Parkinson Disease and Movement Disorders, Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Erin Jesse
- Department of Chemistry, Ohio State University, Columbus, Ohio
| | - Lilia Lovera
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
| | - Alok Kumar Dwivedi
- Department of Biomedical Sciences, Division of Biostatistics and Epidemiology, Texas Tech University Health Sciences Center El Paso, El Paso, Texas
| | - Alberto J Espay
- James J. and Joan A. Gardner Center for Parkinson Disease and Movement Disorders, Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio.
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Caproni S, Colosimo C. Movement disorders and cerebrovascular diseases: from pathophysiology to treatment. Expert Rev Neurother 2016; 17:509-519. [DOI: 10.1080/14737175.2017.1267566] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Stefano Caproni
- Dipartimento di Neuroscienze, Azienda Ospedaliero-Universitaria Santa Maria, Terni, Italy
| | - Carlo Colosimo
- Dipartimento di Neuroscienze, Azienda Ospedaliero-Universitaria Santa Maria, Terni, Italy
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5
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Alqwaifly M. Treatment responsive Holmes tremor: case report and literature review. Int J Health Sci (Qassim) 2016; 10:558-562. [PMID: 27833521 PMCID: PMC5085351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Holmes tremor is a rare symptomatic movement disorder, characterized by a combination of resting, postural, and action tremors. It is usually caused by lesions involving the brainstem, thalamus, and cerebellum. It is often difficult to treat, many medications have been used with varying degrees of success. It may respond to stereotactic thalamotomy and deep brain stimulation in ventralis intermedius nucleus. Here I report a case of Holmes tremor secondary to multiple sclerosis that treated with L-dopa/carpidopa and showed marked improvement. A relevant literature search was performed, using PubMed for Holmes tremor as labelled in the literature. I included all patients diagnosed with Holmes tremor who responded to medical treatment. I found 27 cases, which are summarized in this review. This report describes a patient with Holmes tremor, who responded very well to Levodopa. This outcome suggests that Levodopa should be considered in the initial management of Holmes tremor.
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Affiliation(s)
- Mohammed Alqwaifly
- Correspondence: Mohammed A. Alqwaifly, MD, Department of Neurosciences, King Faisal Specialist Hospital & Research Centre (Gen.Org.), P.O. Box 3354, Riyadh 11211, Kingdom of Saudi Arabia, Tel. No: 00966 (11) 464-7272 ext. 32229, Phone: 00966 (50) 005-7776,
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6
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Choi SM. Movement Disorders Following Cerebrovascular Lesions in Cerebellar Circuits. J Mov Disord 2016; 9:80-8. [PMID: 27240809 PMCID: PMC4886204 DOI: 10.14802/jmd.16004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 03/04/2016] [Accepted: 03/30/2016] [Indexed: 12/29/2022] Open
Abstract
Cerebellar circuitry is important to controlling and modifying motor activity. It conducts the coordination and correction of errors in muscle contractions during active movements. Therefore, cerebrovascular lesions of the cerebellum or its pathways can cause diverse movement disorders, such as action tremor, Holmes’ tremor, palatal tremor, asterixis, and dystonia. The pathophysiology of abnormal movements after stroke remains poorly understood. However, due to the current advances in functional neuroimaging, it has recently been described as changes in functional brain networks. This review describes the clinical features and pathophysiological mechanisms in different types of movement disorders following cerebrovascular lesions in the cerebellar circuits.
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Affiliation(s)
- Seong-Min Choi
- Department of Neurology, Chonnam National University Medical School, Gwangju, Korea
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7
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Raina GB, Cersosimo MG, Folgar SS, Giugni JC, Calandra C, Paviolo JP, Tkachuk VA, Zuñiga Ramirez C, Tschopp AL, Calvo DS, Pellene LA, Uribe Roca MC, Velez M, Giannaula RJ, Fernandez Pardal MM, Micheli FE. Holmes tremor: Clinical description, lesion localization, and treatment in a series of 29 cases. Neurology 2016; 86:931-8. [PMID: 26865524 PMCID: PMC4782118 DOI: 10.1212/wnl.0000000000002440] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 11/16/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe the clinical features, etiology, findings from neuroimaging, and treatment results in a series of 29 patients with Holmes tremor (HT). METHODS A retrospective study was performed based on review of medical records and videos of patients with HT diagnosis. RESULTS A total of 16 women and 13 men were included. The mean age at the moment of CNS insult was 33.9 ± 20.1 years (range 8-76 years). The most common causes were vascular (48.3%), ischemic, or hemorrhagic. Traumatic brain injury only represented 17.24%; other causes represented 34.5%. The median latency from lesion to tremor onset was 2 months (range 7 days-228 months). The most common symptoms/signs associated with HT were hemiparesis (62%), ataxia (51.7%), hypoesthesia (27.58%), dystonia (24.1%), cranial nerve involvement (24.1%), and dysarthria (24.1%). Other symptoms/signs were vertical gaze disorders (6.8%), bradykinesia/rigidity (6.8%), myoclonus (3.4%), and seizures (3.4%). Most of the patients had lesions involving more than one area. MRI showed lesions in thalamus or midbrain or cerebellum in 82.7% of the patients. Levodopa treatment was effective in 13 out of 24 treated patients (54.16%) and in 3 patients unilateral thalamotomy provided excellent results. CONCLUSIONS The most common causes of HT in our series were vascular lesions. The most common lesion topography was mesencephalic, thalamic, or both. Treatment with levodopa and thalamic stereotactic lesional surgery seems to be effective.
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Affiliation(s)
- Gabriela B Raina
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Maria G Cersosimo
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Silvia S Folgar
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Juan C Giugni
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Cristian Calandra
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Juan P Paviolo
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Veronica A Tkachuk
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Carlos Zuñiga Ramirez
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Andrea L Tschopp
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Daniela S Calvo
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Luis A Pellene
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Marcela C Uribe Roca
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Miriam Velez
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Rolando J Giannaula
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Manuel M Fernandez Pardal
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Federico E Micheli
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru.
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8
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Raina GB, Cersosimo MG, Folgar SS, Giugni JC, Calandra C, Paviolo JP, Tkachuk VA, Zuñiga Ramirez C, Tschopp AL, Calvo DS, Pellene LA, Uribe Roca MC, Velez M, Giannaula RJ, Fernandez Pardal MM, Micheli FE. Holmes tremor: Clinical description, lesion localization, and treatment in a series of 29 cases. Neurology 2016. [PMID: 26865524 DOI: 10.1212/wnl.0000000000002440.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe the clinical features, etiology, findings from neuroimaging, and treatment results in a series of 29 patients with Holmes tremor (HT). METHODS A retrospective study was performed based on review of medical records and videos of patients with HT diagnosis. RESULTS A total of 16 women and 13 men were included. The mean age at the moment of CNS insult was 33.9 ± 20.1 years (range 8-76 years). The most common causes were vascular (48.3%), ischemic, or hemorrhagic. Traumatic brain injury only represented 17.24%; other causes represented 34.5%. The median latency from lesion to tremor onset was 2 months (range 7 days-228 months). The most common symptoms/signs associated with HT were hemiparesis (62%), ataxia (51.7%), hypoesthesia (27.58%), dystonia (24.1%), cranial nerve involvement (24.1%), and dysarthria (24.1%). Other symptoms/signs were vertical gaze disorders (6.8%), bradykinesia/rigidity (6.8%), myoclonus (3.4%), and seizures (3.4%). Most of the patients had lesions involving more than one area. MRI showed lesions in thalamus or midbrain or cerebellum in 82.7% of the patients. Levodopa treatment was effective in 13 out of 24 treated patients (54.16%) and in 3 patients unilateral thalamotomy provided excellent results. CONCLUSIONS The most common causes of HT in our series were vascular lesions. The most common lesion topography was mesencephalic, thalamic, or both. Treatment with levodopa and thalamic stereotactic lesional surgery seems to be effective.
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Affiliation(s)
- Gabriela B Raina
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Maria G Cersosimo
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Silvia S Folgar
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Juan C Giugni
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Cristian Calandra
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Juan P Paviolo
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Veronica A Tkachuk
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Carlos Zuñiga Ramirez
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Andrea L Tschopp
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Daniela S Calvo
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Luis A Pellene
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Marcela C Uribe Roca
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Miriam Velez
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Rolando J Giannaula
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Manuel M Fernandez Pardal
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Federico E Micheli
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru.
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9
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Deep brain stimulation of the globus pallidus internus or ventralis intermedius nucleus of thalamus for Holmes tremor. Neurosurg Rev 2015; 38:753-63. [DOI: 10.1007/s10143-015-0636-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 10/06/2014] [Accepted: 01/19/2015] [Indexed: 10/23/2022]
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10
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Phielipp NM, Chen R. Neurophysiologic Assessment of Movement Disorders in Humans. Mov Disord 2015. [DOI: 10.1016/b978-0-12-405195-9.00010-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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11
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Martínez-Simón J, Sáez-Zea C, Katati MJ, Escamilla-Sevilla F, Mínguez-Castellanos A. Posthemorrhagic Hemiparkinsonism Treated by Unilateral Pallidal Stimulation. Mov Disord Clin Pract 2014; 1:139-141. [DOI: 10.1002/mdc3.12024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 02/13/2014] [Accepted: 03/25/2014] [Indexed: 11/10/2022] Open
Affiliation(s)
- Josefina Martínez-Simón
- Department of Neurology; Instituto de Investigación Biosanitaria de Granada; Hospital Universitario Virgen de las Nieves; Granada Spain
| | - Carmen Sáez-Zea
- Department of Neurology; Instituto de Investigación Biosanitaria de Granada; Hospital Universitario Virgen de las Nieves; Granada Spain
- Area of Psychobiology; Department of Psychology; Faculty of Humanities and Education; University of Jaén; Jaén Spain
| | - Majed J. Katati
- Department of Neurosurgery; Instituto de Investigación Biosanitaria de Granada; Hospital Universitario Virgen de las Nieves; Granada Spain
| | - Francisco Escamilla-Sevilla
- Department of Neurology; Instituto de Investigación Biosanitaria de Granada; Hospital Universitario Virgen de las Nieves; Granada Spain
| | - Adolfo Mínguez-Castellanos
- Department of Neurology; Instituto de Investigación Biosanitaria de Granada; Hospital Universitario Virgen de las Nieves; Granada Spain
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12
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Woo JH, Hong BY, Kim JS, Moon SH, Kim SY, Han HY, Park DY, Lim SH. Holmes tremor after brainstem hemorrhage, treated with levodopa. Ann Rehabil Med 2013; 37:591-4. [PMID: 24020044 PMCID: PMC3764358 DOI: 10.5535/arm.2013.37.4.591] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 10/17/2012] [Indexed: 11/26/2022] Open
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.
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Affiliation(s)
- Jae Hyun Woo
- Department of Rehabilitation Medicine, St. Vincent Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
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13
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Abstract
Hemiparkinsonism secondary to a vascular mesencephalic lesion is infrequent; these patients offer an exceptional opportunity to study neuropsychological alterations attributable to unilateral dopaminergic denervation, shedding light on the pathophysiology of cognitive disorders in early-stage idiopathic Parkinson's disease (PD). From the investigation of our case, we conclude that destruction of the right nigrostriatal pathway is accompanied by deficits in executive functioning and verbal/visual memory similar to those observed in many patients with early-stage idiopathic PD. The more complex neuropsychological dysfunction developed by other PD patients must therefore be related to the additional involvement of other brain structures.
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14
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Abstract
Movement disorders can occur as primary (idiopathic) or genetic disease, as a manifestation of an underlying neurodegenerative disorder, or secondary to a wide range of neurological or systemic diseases. Cerebrovascular diseases represent up to 22% of secondary movement disorders, and involuntary movements develop after 1-4% of strokes. Post-stroke movement disorders can manifest in parkinsonism or a wide range of hyperkinetic movement disorders including chorea, ballism, athetosis, dystonia, tremor, myoclonus, stereotypies, and akathisia. Some of these disorders occur immediately after acute stroke, whereas others can develop later, and yet others represent delayed-onset progressive movement disorders. These movement disorders have been encountered in patients with ischaemic and haemorrhagic strokes, subarachnoid haemorrhage, cerebrovascular malformations, and dural arteriovenous fistula affecting the basal ganglia, their connections, or both.
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Affiliation(s)
- Raja Mehanna
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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15
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Affiliation(s)
- Hrishikesh Kumar
- Movement Disorders Program, Division of Neurology, University of Western Ontario, London, Ont.
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16
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Raina GB, Velez M, Pardal MF, Micheli F. Holmes tremor secondary to brainstem hemorrhage responsive to levodopa: report of 2 cases. Clin Neuropharmacol 2007; 30:95-100. [PMID: 17414941 DOI: 10.1097/01.wnf.0000240957.56939.e6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report 2 patients who presented a brainstem hemorrhage and who, after 1 and 6 months, respectively, developed a 4-Hz postural and resting tremor consistent with Holmes tremor, which severely interfered with the activities of daily living. In both cases, levodopa dramatically improved the tremor. Pharmacological treatment of this condition is usually disappointing, and surgical procedures are commonly required for severe cases. Our patients, together with 13 others gleaned from the literature, suggest that in cases of Holmes tremor secondary to brainstem hemorrhage, levodopa can be a useful treatment, and it should be tested before considering invasive therapies.
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Affiliation(s)
- Gabriela B Raina
- Parkinson's Disease and Movement Disorders Unit, Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
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17
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Cannon JR, Nakamura T, Keep RF, Richardson RJ, Hua Y, Xi G. Dopamine changes in a rat model of intracerebral hemorrhage. ACTA NEUROCHIRURGICA. SUPPLEMENT 2006; 96:222-6. [PMID: 16671459 DOI: 10.1007/3-211-30714-1_48] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Recent case reports suggest that dopamine (DA) replacement may reduce behavioral deficits resulting from hemorrhages along the nigrostriatal tract. In the rat model of intracerebral hemorrhage (ICH), behavioral deficits are first evident on day 1, with return to near control levels by day 28. The current study was conducted to determine if striatal dopamine alterations are correlated with behavioral deficits. Gamma-aminobutyric acid (GABA) levels were measured to determine selectivity. Striatal DA, DA metabolites, and GABA were determined at days 1, 3, 7, and 28 after ICH by high-pressure liquid chromatography with electrochemical detection. ICH resulted in significant increases above control in DA contralateral to the lesion (177 to 361% above control, days 1 to 28). There were also significant, but much less marked changes in GABA. In the ipsilateral striatum, significant DA increases also occurred (approximately 200%, at day 3 and approximately 275% day 28), while GABA alterations were not significant. These results indicate that the striatal DA system is selectively altered after ICH. Further studies will be needed to determine if regional dopamine alterations occur relative to the location of the hematoma.
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Affiliation(s)
- J R Cannon
- Department of Environmental Health Sciences, University of Michigan Medical School, Ann Arbor, MI 48109-0532, USA
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18
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Abstract
The present review is aimed at providing practical assistance to the clinical neurologist in reaching a diagnosis, understanding the pathogenic mechanisms of movement disorders associated with systemic diseases, and determining appropriate therapy. Infectious disease by direct effect or as an acquired autoimmune neurological disease, stroke, hypoxia-ischemia, paraneoplastic syndromes, collagen disorders, endocrine, liver and kidney diseases that may cause hypokinetic or hyperkinetic abnormal movement are considered separately. The type and evolution of abnormal movement caused by systemic disease vary with age and underlying pathology. Therapy for abnormal movements should include a primary treatment for the systemic disease.
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Affiliation(s)
- Fernando Alarcón
- Department of Neurology, Eugenio Espejo Hospital, P.O. Box 17-07-9515, Quito, Ecuador.
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Alarcón F, Zijlmans JCM, Dueñas G, Cevallos N. Post-stroke movement disorders: report of 56 patients. J Neurol Neurosurg Psychiatry 2004; 75:1568-74. [PMID: 15489389 PMCID: PMC1738792 DOI: 10.1136/jnnp.2003.011874] [Citation(s) in RCA: 157] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Although movement disorders that occur following a stroke have long been recognised in short series of patients, their frequency and clinical and imaging features have not been reported in large series of patients with stroke. METHODS We reviewed consecutive patients with involuntary abnormal movements (IAMs) following a stroke who were included in the Eugenio Espejo Hospital Stroke Registry and they were followed up for at least one year after the onset of the IAM. We determined the clinical features, topographical correlations, and pathophysiological implications of the IAMs. RESULTS Of 1500 patients with stroke 56 developed movement disorders up to one year after the stroke. Patients with chorea were older and the patients with dystonia were younger than the patients with other IAMs. In patients with isolated vascular lesions without IAMs, surface lesions prevailed but patients with deep vascular lesions showed a higher probability of developing abnormal movements. One year after onset of the IAMs, 12 patients (21.4%) completely improved their abnormal movements, 38 patients (67.8%) partially improved, four did not improve (7.1%), and two patients with chorea died. In the nested case-control analysis, the patients with IAMs displayed a higher frequency of deep lesions (63% v 33%; OR 3.38, 95% CI 1.64 to 6.99, p<0.001). Patients with deep haemorrhagic lesions showed a higher probability of developing IAMs (OR 4.8, 95% CI 0.8 to 36.6). CONCLUSIONS Chorea is the commonest movement disorder following stroke and appears in older patients. Involuntary movements tend to persist despite the functional recovery of motor deficit. Deep vascular lesions are more frequent in patients with movement disorders.
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Affiliation(s)
- F Alarcón
- Department of Neurology, Eugenio Espejo Hospital, PO Box 17-07-9515, Quito, Ecuador, South America.
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20
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Romanelli P, Brontë-Stewart H, Courtney T, Heit G. Possible necessity for deep brain stimulation of both the ventralis intermedius and subthalamic nuclei to resolve Holmes tremor. Case report. J Neurosurg 2003; 99:566-71. [PMID: 12959446 DOI: 10.3171/jns.2003.99.3.0566] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Holmes tremor is characterized by resting, postural, and intention tremor. Deep brain stimulation (DBS) of both the nucleus ventralis intermedius (Vim) and the subthalamic nucleus (STN) may be required to control these three tremor components. A 79-year-old man presented with a long-standing combination of resting, postural, and intention tremor, which was associated with severe disability and was resistant to medical treatment. Neuroimaging studies failed to reveal areas of discrete brain damage. A DBS device was placed in the Vim and produced an improvement in both the intention and postural tremor, but there was residual resting tremor, as demonstrated by clinical observation and quantitative tremor analysis. Placement of an additional DBS device in the STN resolved the resting tremor. Stimulation of the Vim or STN alone failed to produce global resolution of mixed tremor, whereas combined Vim-STN stimulation produced global relief without creating noticeable side effects. Combined Vim-STN stimulation can thus be a safe and effective treatment for Holmes tremor.
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Affiliation(s)
- Pantaleo Romanelli
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California 94305-5327, USA
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21
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Zijlmans J, Booij J, Valk J, Lees A, Horstink M. Posttraumatic tremor without parkinsonism in a patient with complete contralateral loss of the nigrostriatal pathway. Mov Disord 2002; 17:1086-8. [PMID: 12360565 DOI: 10.1002/mds.10203] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We present a patient with posttraumatic tremor who did not show any [(123)I]FP-CIT uptake in the contralateral putamen and caudate. The absence of hypokinesia and rigidity is surprising in the presence of a striatal dopaminergic denervation that is even more severe than in Parkinson's disease. An explanation, therefore, could be that the lesion in the subthalamic nucleus in our patient prevented the onset of a Parkinson syndrome.
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Affiliation(s)
- Jan Zijlmans
- Department of Neurology, The National Institute of Neurology and Neurosurgery, Queen Square, London, United Kingdom.
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22
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Affiliation(s)
- Miriam Vélez
- Movement Disorders Unit, Instituto de Ciencias Neurológicas Oscar Trelles Montes Lima, Peru
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23
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Ling MJ, Aggarwal A, Morris JGL. Dopa-responsive parkinsonism secondary to right temporal lobe haemorrahage. Mov Disord 2002; 17:402-4. [PMID: 11921132 DOI: 10.1002/mds.10081] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
A 46-year-old man developed a symmetrical parkinsonian syndrome 7 weeks after large right temporal intracerebral haemorrhage resulting from a ruptured arteriovenous malformation. His signs included bradykinesia, rigidity, start hesitation, and poor postural reflexes, without a resting tremor. He also had signs of a Parinaud's syndrome. Computed tomography and magnetic resonance imaging of the brain demonstrated changes in the right temporal lobe associated with the haemorrhage but no abnormality of the basal ganglia or midbrain. Levodopa therapy produced a dramatic improvement within a few days of commencement. We postulate that the parkinsonism resulted from midbrain compression secondary to transtentorial herniation. Although parkinsonism is a rare complication of lobar intracerebral haemorrhage, it is important to recognise as it may be potentially treatable.
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Affiliation(s)
- Monica J Ling
- Department of Rehabilitation, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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Pezzini A, Zavarise P, Palvarini L, Viale P, Oladeji O, Padovani A. Holmes' tremor following midbrain Toxoplasma abscess: clinical features and treatment of a case. Parkinsonism Relat Disord 2002; 8:177-80. [PMID: 12039428 DOI: 10.1016/s1353-8020(01)00013-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The label Holmes' tremor defines a rare symptomatic movement disorder frequently occurring with midbrain damage. It appears at rest and worsens adopting a posture and on attempting movements. We describe the case of a patient with Holmes' tremor due to a presumed Toxoplasma abscess of the midbrain. The positive response to a combined therapy with levodopa and isoniazid is also reported.
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Affiliation(s)
- A Pezzini
- Department of Neurology, University of Brescia, Brescia, Italy.
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25
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Kudo M, Goto S, Nishikawa S, Hamasaki T, Soyama N, Ushio Y, Mita S, Hirata Y. Bilateral thalamic stimulation for Holmes' tremor caused by unilateral brainstem lesion. Mov Disord 2001; 16:170-4. [PMID: 11215584 DOI: 10.1002/1531-8257(200101)16:1<170::aid-mds1033>3.0.co;2-p] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- M Kudo
- Department of Neurosurgery, Kumamoto University Medical School, Japan
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Eberling JL, Pivirotto P, Bringas J, Bankiewicz KS. Tremor is associated with PET measures of nigrostriatal dopamine function in MPTP-lesioned monkeys. Exp Neurol 2000; 165:342-6. [PMID: 10993693 DOI: 10.1006/exnr.2000.7470] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Unilateral intracarotid artery (ICA) MPTP infusion, along with sequential systemic doses of MPTP, produces near complete degeneration of the nigrostriatal pathway on the side of infusion (ipsilateral) and variable levels of damage in the contralateral hemisphere accompanied by varying levels of parkinsonism (overlesioned hemiparkinsonian model). Positron emission tomography and the dopamine (DA) metabolism tracer [(18)F]6-fluoro-l-m-tyrosine (FMT) were used to evaluate the relationship between DA metabolism and clinical features of parkinsonism in 14 overlesioned hemiparkinsonian monkeys. Monkeys were rated on a parkinsonian scale that included ratings of bradykinesia, fine motor skills (FMS), and rest tremor. Because the monkeys tended to show more severe clinical signs on the side of the body contralateral to ICA MPTP infusion, we calculated asymmetry scores for each of the clinical features as well as for FMT uptake (K(i)) in the caudate and putamen. Tremor asymmetry was associated with FMT uptake asymmetry in the putamen. No such relationship was observed for FMS or bradykinesia. The overall severity of tremor (mild, moderate/severe) was associated with FMT uptake in the caudate and putamen. Postmortem biochemical analysis for a subset of monkeys showed that the monkeys with moderate/severe tremor had significantly lower DA levels in both caudate and putamen than those with mild tremor. In addition, K(i) values were significantly correlated with DA levels in both caudate and putamen. These findings support the idea that nigrostriatal degeneration contributes to rest tremor.
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Affiliation(s)
- J L Eberling
- Center for Functional Imaging, Lawrence Berkeley National Laboratory, 1 Cyclotron Road, Mail Stop 55-121, Berkeley, California 94720, USA
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Cassim F, Derambure P, Defebvrè L, Bourriez JL, Destée A, Guieu JD. [Neurophysiologic study of tremor]. Neurophysiol Clin 2000; 30:81-96. [PMID: 10812577 DOI: 10.1016/s0987-7053(00)00060-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Tremor is frequently encountered in neurologic practice. Clinical examination supplies information regarding its approximative frequency, regularity, amplitude, topography and activation conditions. The neurophysiological study helps in confirming the tremor, in differentiating it from other movement disorders like myoclonus, and may provide distinctive features which are important for the aetiological diagnosis. The neurophysiological investigation includes accelerometry, which analyses the mechanics of the movement. Spectral analysis with FFT allows the determination of frequency and amplitude. Accelerometry is always associated with surface EMG of at least two antagonistic muscles. It may show rhythmic bursts, their frequency, duration and activation pattern (alternating or synchronous). This neurophysiological approach to tremor has multiple interests. It may help in differentiating a true rest tremor from a postural tremor seemingly persisting at rest. Brief interruptions or rhythm breaks during distraction manoeuvers are seen in psychogenic tremors. Surface EMG may also demonstrate positive myoclonic bursts, or brief silent periods corresponding to negative myoclonus, sometimes pseudorhythmic, thus appearing clinically like a tremor, but investigations, aetiologies and treatment are different. Several features, especially slow frequency, may suggest a midbrain tremor, thus requiring brain imagery centered around the posterior fossa. Finally, the neurophysiological examination is the only way to demonstrate a primary writing tremor, or a primary orthostatic tremor, the frequency of which is pathognomonic while clinical symptoms are rather misleading.
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Affiliation(s)
- F Cassim
- Service de neurophysiologie clinique, hôpital Roger Salengro, CHU Lille, France
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Deuschl G, Bain P, Brin M. Consensus statement of the Movement Disorder Society on Tremor. Ad Hoc Scientific Committee. Mov Disord 1998; 13 Suppl 3:2-23. [PMID: 9827589 DOI: 10.1002/mds.870131303] [Citation(s) in RCA: 873] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
This is a proposal of the Movement Disorder Society for a clinical classification of tremors. The classification is based on the distinction between rest, postural, simple kinetic, and intention tremor (tremor during target-directed movements). Additional data from a medical history and the results of a neurologic examination can be combined into one of the following clinical syndromes defined in this statement: enhanced physiologic tremor, classical essential tremor (ET), primary orthostatic tremor, task- and position-specific tremors, dystonic tremor, tremor in Parkinson's disease (PD), cerebellar tremor, Holmes' tremor, palatal tremor, drug-induced and toxic tremor, tremor in peripheral neuropathies, or psychogenic tremor. Conditions such as asterixis, epilepsia partialis continua, clonus, and rhythmic myoclonus can be misinterpreted as tremor. The features distinguishing these conditions from tremor are described. Controversial issues are outlined in a comment section for each item and thus reflect the open questions that at present cannot be answered on a scientific basis. We hope that this statement provides a basis for better communication among clinicians working in the field and stimulates tremor research.
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Affiliation(s)
- G Deuschl
- Neurologische Klinik der Christian-Albrechts-Universität zu Kiel, Germany
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Abstract
Symptomatic tremors are labeled in the literature under different names including rubral tremor, midbrain tremor, thalamic tremor, myorhythmia, Holmes' tremor, cerebellar tremor, and goal-directed tremor. The most common tremor is a delayed-onset postural and action tremor with a low frequency of 3 Hz and a proximal distribution. Resting irregular tremor is sometimes present. Mild cerebellar dysmetria is often detected. The lesions are mainly located in the thalamus, the brain stem, and the cerebellum, with secondary interruption and degeneration of various pathways and olivary hypertrophy. The more consistent lesions are found in the cerebello-thalamo-cortical and dentato-rubro-olivary pathways. The role of superimposed dysfunction of the nigrostriatal system may account for the rest component. The role of the basal ganglia in the emergence and control of tremor is poorly understood.
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Affiliation(s)
- M Vidailhet
- INSERM U289, Hôpital de la Salpêtrière, Paris, France
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Milanov I, Bogdanova D, Georgiev D. Contralateral hemi-parkinsonism and atypical tremor after stroke (a case report). Parkinsonism Relat Disord 1998; 4:143-5. [DOI: 10.1016/s1353-8020(98)00021-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/1998] [Revised: 06/30/1998] [Indexed: 10/18/2022]
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Shepherd GM, Tauböll E, Bakke SJ, Nyberg-Hansen R. Midbrain tremor and hypertrophic olivary degeneration after pontine hemorrhage. Mov Disord 1997; 12:432-7. [PMID: 9159743 DOI: 10.1002/mds.870120327] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
A severe rest tremor arose in a patient's right arm 9 months after a pontine tegmental hemorrhage. Magnetic resonance studies at 4 and 10 months showed residual hemosiderin in the pons and increasing hypertrophic olivary degeneration (HOD) affecting primarily the left olive. The tremor was refractory to pharmacotherapy (clonazepam, propranolol, and levodopa), but was reduced after implantation of a thalamic stimulator device. Although pontine hemorrhage is among several common causes of HOD, it has not previously been appreciated as a cause of midbrain ("rubral") tremor. A disynaptic dentatorubroolivary tract associated with tremor and monosynaptic dentatoolivary tract associated with HOD may both be components of the rubroolivocerebellorubral loop implicated in midbrain tremor. Their proximity makes the combination of tremor and HOD after pontine tegmental damage plausible and even likely.
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Affiliation(s)
- G M Shepherd
- Department of Neurology, National Hospital, University of Oslo, Norway
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Borrás JM, Salazar FG, Grandas F. Oculomotor palsy and contralateral tremor (Benedikt's syndrome) following a stereotactic procedure. J Neurol 1997; 244:272-4. [PMID: 9112599 DOI: 10.1007/s004150050085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Abe K, Yanagihara T. Hemiparkinsonism following haemorrhage in the contralateral substantia nigra. Neuroradiology 1996; 38 Suppl 1:S67-9. [PMID: 8811683 DOI: 10.1007/bf02278122] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We report a patient with right hemiparkinsonism following haemorrhage in the left substantia nigra. The hemiparkinsonism responded to treatment with trihexyphenidyl hydrochloride and deteriorated after temporary discontinuation of the drug. Single photon emission computed tomography using technetium 99m d, l-hexamethylpropyleneamine oxide showed reduced uptake in the left putamen, globus pallidus and thalamus.
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Affiliation(s)
- K Abe
- Department of Neurology, Osaka University Hospital, Japan
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Abstract
The diagnosis of movement disorders is essentially clinical. Work-up depends on patient age, part of the body affected, drug response, and presence of other systemic or neurologic symptoms and signs. Typical Parkinson's disease, essential tremor, and tics need only minimal work-up if any. Brain magnetic resonance imaging/computed tomography, positron emission tomography and single photon emission computed tomography, and DNA studies are promising diagnostic tools. Exclusion of Wilson's disease and neuroacanthocytosis is emphasized in children and young adults with movement disorders.
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Affiliation(s)
- A Anouti
- Department of Neurology, University of Kansas Medical Center, Kansas City, USA
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Kulisevsky J, Avila A, Berthier ML. Bipolar affective disorder and unilateral parkinsonism after a brainstem infarction. Mov Disord 1995; 10:799-802. [PMID: 8750004 DOI: 10.1002/mds.870100618] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- J Kulisevsky
- Department of Neurology, Sant Pau Hospital, Autonomous University of Barcelona, Spain
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