Thalamic Infarction and Rubral Tremor

Two children, ages 14 months and 9 years, with a combined resting-postural-kinetic tremor following bilateral thalamic infarction are reported from Ataturk University, and Hacettepe University, Ankara, Turkey. The 14 month-old child had been treated with surgery and chemotherapy for Wilms’ tumor. One week after completion of chemotherapy, he was admitted with high fever, and 3 days later, he developed a resting tremor in all limbs. This was complicated after 24 hours by 3-Hz clonic movements on the right side including the tongue. The movements tended to lessen in sleep. Two subsequent afebrile generalized seizures were associated with generalized spike and wave discharges on EEG, maximal amplitude over the left frontal area, and confirmed by video-EEG. Diazepam obliterated the EEG discharges, but the resting tremor persisted. The paroxysmal activity and tremor were thought to be independent. MRI of both patients showed bilateral, ischemic lesions in the medial thalami. Seizure and tremor responded to valproate and benztropine. The second patient had only resting tremor and the EEG was normal. [1]