CASE REPORT   

Journal of Neurosurgical Sciences 2017 October;61(5):544-6

DOI: 10.23736/S0390-5616.16.03229-X

Copyright © 2015 EDIZIONI MINERVA MEDICA

language: English

VIM thalamotomy in the treatment of Holmes’ tremor secondary to HIV-associated midbrain lesion: a case report

José O. OLIVEIRA Jr ^{1, 2}, Soraya A. JORGE CECILIO ¹, Matheus FERNANDES OLIVEIRA ¹ ✉, Leonardo R. TAKAHASHI ², Alexandro R. GALASSI ², Vanessa M. HOLANDA ², José M. ROTTA ¹

¹ Department of Neurosurgery, São Paulo State Hospital, São Paulo, Brazil; ² Clinic for Functional and Stereotactic Neurosurgery and Pain, Antonio Prudente Camargo Cancer Center, São Paulo, Brazil

Holmes’ tremor (rubral tremor, cerebellar outflow tremor) is characterized by rest, intention and postural tremor, often localized to one upper extremity, associated with ipsilateral dysmetria and dysdiadochokinesia. We describe a case of successful treatment of Holmes’ tremor with unilateral nucleus ventralis intermedius (VIM) thalamotomy. The subject is a 43-year-old woman with unremarkable previous medical history. She presented with complete left hemiparesis in the context of human immunodeficiency syndrome and the magnetic resonance image disclosed a contrast-enhancing lesion in right brain peduncle, in topography of red nucleus. She developed a progressive rest, intention and postural tremor in left upper limb. She was submitted to a stereotactic biopsy and the tremor became worse. She performed awake right VIM thalamotomy, with immediate complete resolution of tremor. There were no complications after procedure, and the result is stable after six months. We highlight the role of thalamotomy in cases like ours, once patient recovered well and, due to HIV, will need further neuroimage studies to evaluate neurologic complications of HIV. Deep brain stimulation in such cases may interfere with coming neuroimage quality and may act like a foreign body.

KEY WORDS: Tremor - Lesion - Ventral Thalamic nuclei