Ann Rehabil Med.  2014 Oct;38(5):694-697. 10.5535/arm.2014.38.5.694.

Effect of Ultrasonography-Guided Botulinum Toxin Type A Injection in Holmes' Tremor Secondary to Pontine Hemorrhage: Case Report

• Ahn SY
• Kim DA
• Park YO
• Shin JH

• KMID: 2266505
• DOI: http://doi.org/10.5535/arm.2014.38.5.694

Abstract

Holmes' tremor is a low-frequency rest and intentional tremor secondary to various insults, including cerebral ischemia, hemorrhage, trauma, or neoplasm. Pharmacologic treatment is usually unsuccessful, and some cases require surgical intervention. We report a rare case of Holmes' tremor secondary to left pontine hemorrhage in a 29-year-old Asian male patient who developed 1.6-Hz postural and rest tremor of the right hand. He responded markedly to ultrasonography-guided botulinum toxin type A injection. To our knowledge, this is the first report of Homes' tremor treated with ultrasonography-guided botulinum toxin type A injection with favorable results.

Keyword

Tremor; Botulinum toxins; Ultrasonography

MeSH Terms

Adult
Asian Continental Ancestry Group
Botulinum Toxins
Botulinum Toxins, Type A*
Brain Ischemia
Hand
Hemorrhage*
Humans
Male
Tremor*
Ultrasonography
Botulinum Toxins
Botulinum Toxins, Type A

Figure

• 

  Fig. 1 (A) Axial fluid-attenuated inversion recovery and (B) T2-weighted magnetic resonance imaging scans (inset) showing acute intracerebral hemorrhage in the left pons (arrow).

• 

  Fig. 2 Ultrasonographic image of the right second flexor digitorum superficialis (FDS2). The needle (arrowheads) is advanced into the FDS2 under real-time ultrasonography guidance.

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