TY - JOUR T1 - Disruption of nigrostriatal and cerebellothalamic pathways in dopamine responsive Holmes’ tremor JF - Journal of Neurology, Neurosurgery & Psychiatry JO - J Neurol Neurosurg Psychiatry SP - 921 LP - 923 DO - 10.1136/jnnp.2008.146324 VL - 80 IS - 8 AU - S Seidel AU - G Kasprian AU - F Leutmezer AU - D Prayer AU - E Auff Y1 - 2009/08/01 UR - http://jnnp.bmj.com/content/80/8/921.abstract N2 - Holmes’ tremor is an unusual combination of rest, postural and kinetic tremor of the extremities. Medical treatment of this condition still remains unsatisfactory. The case of a 20-year-old female patient is reported who developed right-sided Holmes’ tremor 9 months after a left-sided, cavernoma induced midbrain/pontine haemorrhage at the age of 16 years. Beta-CIT single photon emission computed tomography revealed abolished dopamine transporter activity in the left basal ganglia and striatum, in accordance with missing ipsilateral tegmento-frontal connectivity (medial forebrain bundle), demonstrated by diffusion tensor MRI. Tractography showed reduced fibre connectivity of the superior and middle cerebellar peduncles on the lesioned side. Administration of pramipexole and L-DOPA led to a clinically significant reduction in tremor severity. In conclusion, our results support the notion that Holmes’ tremor was a result of diminished striatal dopaminergic input in our patient. ER -