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Holmes tremor, also known as rubral tremor, is defined as the combination of rest, action and postural tremor in the upper extremities with the frequency around 4.5 Hz.1 Involvement of dentato-rubro-thalamic and/or nigrostriatal pathways have been considered contributory to the clinical manifestation,1 and the localisation of Holmes tremor was determined primarily based on the neuroimaging studies.2 To our knowledge, no detailed postmortem examinations were reported in Holmes tremor. Here, we present the pathology of a case with Holmes tremor associated with anti-Yo cerebellar degeneration.
A woman in her eighth decade developed subacute onset of gait ataxia and dysarthria within 6 months. She required a walker to ambulate and needed assistance in her daily living. Four months after the symptom onset, she developed upper extremity tremor and head tremor. Neurological examination revealed square wave jerks, nystagmus on lateral gaze, broken smooth pursuit and scanning speech. She had marked cerebellar ataxia with dysmetria on the bilateral finger-to-nose tests and heel-shin slides. She also had truncal titubation. She had rest head tremor. She also had rest, postural and action tremors in her upper extremities, and the tremor became coarse and irregular with goal-directed movements, …