CASE REPORT: Reversible Holmes’ tremor due to spontaneous intracranial hypotension

Iyer, Rajesh Shankar
Wattamwar, Pandurang
Thomas, Bejoy

¹Department of Neurology, KG Hospital, Coimbatore, Tamil Nadu, India,
²Department of Neurology, United CIIGMA Hospitals, Aurangabad, Maharashtra, India,
³Department of Imaging Sciences and Interventional R, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India,

Correspondence to Dr Rajesh Shankar Iyer, e-mail; [email protected]

/Accepted July 10, 2017; previously published online July 27, 2017

Contributors RSI conceived the idea and designed the paper. PW contributed in the discussion and final draft of the paper. BT contributed in discussion of imaging studies and clinical correlation.

Competing interests None declared.

Patient consent Obtained from guardian.

Provenance and peer review Not commissioned; externally peer reviewed.

BMJ Case Reports 2017:p 220348, January 2017. | DOI: 10.1136/bcr-2017-220348

Holmes’ tremor is a low-frequency hand tremor and has varying amplitude at different phases of motion. It is usually unilateral and does not respond satisfactorily to drugs and thus considered irreversible. Structural lesions in the thalamus and brainstem or cerebellum are usually responsible for Holmes’ tremor. We present a 23-year-old woman who presented with unilateral Holmes’ tremor. She also had hypersomnolence and headache in the sitting posture. Her brain imaging showed brain sagging and deep brain swelling due to spontaneous intracranial hypotension (SIH). She was managed conservatively and had a total clinical and radiological recovery. The brain sagging with the consequent distortion of the midbrain and diencephalon was responsible for this clinical presentation. SIH may be considered as one of the reversible causes of Holmes’ tremor.