Abstract

Holmes tremor is a rare movement disorder. Lesions involving red nucleus and/or affecting the superior cerebellar peduncle or posterior thalamus may cause this tremor. In this article, we report a 19-year-old man who developed a unilateral high-amplitude tremor, approximately two weeks after a head trauma. The tremor showed postural, kinetic and resting properties. Magnetic resonance imaging (MRI) showed a linear fracture line on the right parietal bone and a post-contusional area on the right superior parietal lobe. Cervical MRI was normal. Electromyography recording a 4 Hz tremor activity on the left arm that was arrhythmic with resting, postural and kinetic components. Single photon emission computed tomography of the brain (SPECT) showed hypometabolism on the right temporal, parietal and occipital lobes as well as right thalamus and cerebellum. In conclusion, when Holmes tremor following head trauma is suspected clinically and electrophysiologically and the lesions on the MRI cannot explain the clinical picture, the cerebello-thalamo-cortical loop dysfunction leading to Holmes tremor may be demonstrated with SPECT.