Levodopa-responsive Holmes’ Tremor Caused by a Single Inflammatory Demyelinating Lesion Cover

Levodopa-responsive Holmes’ Tremor Caused by a Single Inflammatory Demyelinating Lesion

Tremor and Other Hyperkinetic Movements

Volume 5 (2015): Issue 0

By: Petra Katschnig-Winter, Mariella Koegl-Wallner, Tamara Pendl, Franz Fazekas and Petra Schwingenschuh

Open Access

|Sep 2015

Figures & Tables

MRI Findings. (A) Baseline: left, transversal FLAIR image; right, transverse T1-weighted image. A 1.1×0.9×1.0-cm gadolinium-enhancing lesion in the right upper cerebral peduncle with perifocal edema is shown. (B) Follow-up MRI after 4 months: left, only a slightly smaller right red nucleus compared to the left, and a small hyperintensity in the area of the right substantia nigra indicating discrete residual changes on T2-weighted imaging; right, complete remission on contrast-enhanced T1-weighted MRI. (C) DaT-SPECT 5 months after symptom onset shows nearly absent DaT binding in the right striatum. Abbreviations: DaT-SPECT, Dopamine Transporter Single-photon Emission Computed Tomography; FLAIR, Fluid-attenuated Inversion Recovery; MRI, Magnetic Resonance Imaging.

Video

Segment 1. Before the introduction of levodopa: subtle dystonic post uring, moderate rest and postural tremor, and severe kinetic tremor of the left arm during finger nose testing and while drawing a spiral. Segment 2. Two weeks after the introduction of levodopa: only mild rest and postural tremors and moderate kinetic tremor of the left arm during finger nose testing were observed. Segment 3. Six months after the introduction of levodopa: no rest tremor, subtle postural tremor, and mild kinetic tremor of the left arm during finger nose testing and while drawing a spira. Note: The patient provided signed informed consent to be videotaped and for the content to be viewed for educational purposes.

DOI: https://doi.org/10.5334/tohm.257 | Journal eISSN: 2160-8288

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Language: English

Submitted on: Jul 22, 2015

Accepted on: Sep 1, 2015

Published on: Sep 25, 2015

Published by: Columbia University Libraries/Information Services

In partnership with: Paradigm Publishing Services

Publication frequency: 1 issue per year

Keywords:

Holmes’ Tremor,

midbrain lesion,

remitting MRI abnormalities,

abnormal DaT-SPECT,

Levodopa responsiveness

© 2015 Petra Katschnig-Winter, Mariella Koegl-Wallner, Tamara Pendl, Franz Fazekas, Petra Schwingenschuh, published by Columbia University Libraries/Information Services
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

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