J Neurol Surg A Cent Eur Neurosurg 2013; 74(04): 271-276
DOI: 10.1055/s-0032-1322549
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Unilateral Thalamic Vim and GPi Stimulation for the Treatment of Holmes' Tremor Caused by Midbrain Cavernoma: Case Report and Review of the Literature

Sabri Aydin
1   Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
Bashar Abuzayed
1   Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
Gunes Kiziltan
2   Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
Aysegul Gunduz
2   Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
Selin Yagci
3   Department of Neuropsychology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
Murat Mengi
4   Department of Physiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
Osman Kizilkilic
5   Department of Neuroradiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
Mustafa Uzan
1   Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
Murat Hanci
1   Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
› Author Affiliations
Further Information

Publication History

02 November 2011

13 December 2011

Publication Date:
14 January 2013 (online)


A 30-year-old man with brainstem cavernoma experienced hemorrhage and was operated in 2008. Six months after the operation, the patient presented with new complaints of left arm tremor namely Holmes' tremor. Neurological examination also revealed left-sided internuclear ophthalmoplegia, left-sided mild paresis, and increased deep tendon reflexes of the left upper extremity, truncal ataxia, and dysarthria. Brain magnetic resonance imaging showed a postoperative cavity and gliosis at the level of the superior and inferior colliculus in the right tegmentum and right red nucleus with extension to the substantia nigra. Fahn–Tolosa–Marin tremor rating scale (TRS) for his left upper extremity (Part A, score 6) was 11 for the proximal and the distal arm. After the failure of medical treatment, the patient underwent right globus pallidum internus and ventral intermediate thalamic nucleus deep brain stimulation. There were no side effects related to the stimulation. Final TRS months after operation was 3 for the proximal and 4 for the distal arm.

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