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Holmes tremor: Application of modern neuroimaging techniques

Authors

  • Dominic C. Paviour MRCP,

    Corresponding author
    1. The Sara Koe PSP Research Centre, The Institute of Neurology, UCL, London, United Kingdom
    • 1 Wakefield Street, London, UK WC1N 1FJ
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  • H. Rolf Jäger FRCR,

    1. The Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, United Kingdom
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  • Leonora Wilkinson PhD,

    1. The Cognitive-Motor Neuroscience Group, Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, Queen Square, London, United Kingdom
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  • Marjan Jahanshahi PhD,

    1. The Cognitive-Motor Neuroscience Group, Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, Queen Square, London, United Kingdom
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  • Andrew J. Lees MD, FRCP

    1. The Sara Koe PSP Research Centre, The Institute of Neurology, UCL, London, United Kingdom
    2. Department of Clinical Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
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Abstract

Holmes tremor has a characteristic rest, intention, and postural component. The syndrome arises as a consequence of a lesion in the upper brainstem and cerebral peduncles, which, it is postulated, interrupts the cerebello-rubrothalamic pathway. Ataxia, ophthalmoplegia, and bradykinesia are associated features. We present a case of Holmes tremor secondary to a midbrain cavernoma. Modern neuroimaging techniques in this case confirm that a combination of damage to the cerebello-rubrothalamic pathway and the nigrostriatal pathway is required for the full Holmes tremor syndrome to occur. © 2006 Movement Disorder Society

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