Neurological Sciences

, Volume 39, Issue 7, pp 1305–1306 | Cite as

Holmes tremor with impairment of the Guillain-Mollaret triangle following medullar hemorrhage

  • Jia-Ming He
  • Jin He
  • Hui-Xia Lin
  • Ning Wang
  • Yu LinEmail author
Letter to the Editor

Dear Sir,

Holmes tremor (HT) is a symptomatic tremor of slow frequency (usually less than 4.5 Hz) and irregular amplitude, with or without ataxia. HT is usually attributed to pathogenic lesions involving the cerebello-thalamo-cortical, dopaminergic nigrostriatal system or the Guillain–Mollaret triangle (GMT) [1, 2]. The GMT is composed of fibers between the red nucleus, the ipsilateral inferior olivary nucleus (IONS), and the contralateral dentate nucleus [3]. It was reported that the most common causes of HT were vascular lesions, among which midbrain, thalamus, and cerebellum were the most frequently affected regions. However, lesions in medulla oblongata have rarely reported in patients with HT so far [4]. In the current study, we presented a HT patient caused by medulla oblongata hemorrhage. Diffusion tensor imaging (DTI) demonstrates the insults of GMT.

A 45-year-old hypertensive male suddenly developed headache, paralysis of the left limbs, dysarthria, and dysphagia. Hemorrhage...



The authors sincerely thank the patient for his help and willingness to take part in this study.

Funding source

This work was supported by grant 81571100 from the National Natural Science Foundation of China.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Supplementary material

10072_2018_3289_MOESM1_ESM.mp4 (35.6 mb)
ESM 1 One month after hemorrhage, the patients showed obscure tremor when siting. After standing, there was tremor on the patient’s upper body while holding the railing or at rest. The tremor was like a wing-beating movement. After treatment of 250/25 mg three times daily of L-dopa/carbidopa for 2 months, the symptoms persisted. (MP4 36,432 kb)


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Copyright information

© Springer-Verlag Italia S.r.l., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of PharmacyFirst Affiliated Hospital, Fujian Medical UniversityFuzhouChina
  2. 2.Department of NeurologyFirst Affiliated Hospital, Fujian Medical UniversityFuzhouChina

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