Department of Neurology, People's Friendship University of Russia, Moscow, Russia.
Department of Medicine, Hope Africa University, Bujumbura, Burundi.
J Neurol. 2021 Nov;268(11):4152-4162. doi: 10.1007/s00415-021-10491-z. Epub 2021 May 11.
Holmes Tremor (HT) is a unique and debilitating movement disorder. It usually results from lesions of the midbrain and its connection but can also result from posterior thalamic injury. Clinical examination can help lesion localization between these two areas. We studied the clinical features and their radiological correlations to distinguish midbrain HT (HT-m) from thalamic HT (HT-t).
Retrospective review of 17 patients with a HT-type presentation was conducted. Tremor characteristics, associated clinical signs and radiological findings were studied.
Eleven patients had a myorythmic rest tremor, large amplitude proximal tremor with goal-directed worsening, with or without mild distal dystonic posturing, representing HT-m. Six patients had slow, large amplitude proximal tremors and distal choreathetoid movements, significant proximal/distal dystonic posturing, associated with proprioceptive sensory loss, representing HT-t. Haemorrhagic lesions were the predominant cause of HT-m; whereas, ischaemia was more commonly associated with HT-t.
When assessing patients with HT, attentiveness to the presence of associated signs in the affected limb, such as a proprioceptive sensory deficits and additional movement disorders, can aid lesion localisation, which can have implications for management.
霍姆斯震颤（HT）是一种独特且使人虚弱的运动障碍。它通常由中脑及其连接的病变引起，但也可由丘脑损伤引起。临床检查有助于在这两个区域之间进行病变定位。我们研究了临床特征及其与影像学的相关性，以区分中脑 HT（HT-m）和丘脑 HT（HT-t）。
对 17 例表现为 HT 型的患者进行回顾性研究。研究了震颤特征、相关临床体征和影像学发现。
11 例患者表现为肌阵挛性静止性震颤，伴有或不伴有轻度远端扭曲性姿势的粗大近端震颤，且有目标指向性加重，代表 HT-m。6 例患者表现为缓慢、粗大的近端震颤和远端舞蹈手足徐动症，有明显的近端/远端扭曲性姿势，伴有本体感觉丧失，代表 HT-t。HT-m 主要由出血性病变引起；而 HT-t 更常见于缺血性病变。
在评估 HT 患者时，注意受影响肢体的伴随体征的存在，如本体感觉缺失和其他运动障碍，可以帮助定位病变，这对治疗有影响。
