[Rubral tremor of Holmes, rare case of pathological tremor: case report].

The authors present a very rare case of Holmes tremor (previously known as rubral or midbrain tremor). In all described till now cases the tremor was due to a known and revealed in laboratory or neuroimaging cause. We present an unusual case of a 42-year old woman with unilateral tremor of right extremities (mostly proximal part of upper extremity) which started abruptly 3 years ago. She had no suffer any serious disease before the onset of symptoms and her family history was also negative. The tremor was present at rest but accelerated during specific postures and active movements. The laboratory tests including: copper and ceruloplasmin concentrations, blood analysis for acanthocytes, evoked potentials, EEG, CT, MRI, MRA and SPECT did not reveal any significant changes. Treatment attempts with neuroleptics, clonazepam, L-dopa, valproic acid, biperiden were almost completely ineffective except local injections of botulinum toxin (Botox, Allergan, 150 U) into the muscles of right arm girdle which moderately alleviated tremor. We did not find any underlying pathology as a cause of tremor, clinically the same as symptomatic cases described in literature. We suggest the possibility of idiopathic origin of tremor in our case, although a very small size of lesion (f.i. ischaemic) could be undetectable in the described tests.

Duke Scholars

Author Allan Howard Friedman Neurosurgery