Holmes’ Midbrain Tremor
Holmes’ tremor, also known as thalamic, midbrain, or rubral tremor, is characterized by a combination of irregular resting, postural, and intention tremors of large amplitude and slow frequency of less than 4.5 Hz. The tremor predominantly affects the proximal upper extremities unilaterally and is often markedly activated by goal-directed movements. Etiology is usually a structural lesion of the brainstem, cerebellum, or thalamus as a result of stroke, vascular malformation, tumor, multiple sclerosis, trauma, or infection. There may be a variable delay of 2 weeks to 2 years between the precipitating event and the initial appearance of tremor.
Holmes midbrain tremor.mp4 (MP4 5,548KB)
Clip 1: the patient exhibits severe postural tremor of the left arm. Not shown are equally severe resting and kinetic tremor. Clip 2: the patient attempts goal-directed arm movements but is unable to carry them out (Video contribution from Dr. Parnsiri Chairangsaris, Pramongkutklao Hospital, Thailand).