Unilateral Holmes tremor and focal dystonia after Gamma Knife surgery

Abstract

✓Holmes tremor is a rare, involuntary slow shaking in the proximal portions of the limbs during rest and voluntary motion. It occurs frequently after midbrain damage. The authors report on a 20-year-old man who developed Holmes tremor after undergoing Gamma Knife surgery for an arteriovenous malformation in the left thalamus extending to the tegmentum. This is possibly the first report of such an adverse effect after radiosurgery. The tremor was believed to be secondary to radiation-induced infarction of the midbrain.

Dystonia in a Patient with Melanoma Metastatic to the Brain Treated with High-Dose Interleukin-2, Radiation Therapy, and Levetiracetam

“…Two case reports have mentioned the development of movement disorders in patients receiving Gamma Knife therapy. The first one is by Chiou et al [6], reporting a 20-year-old patient who developed Holmes tremor after receiving Gamma Knife treatment for arteriovenous malformation. It was strongly suspected that, in this case, focal edema or infarction caused by obliteration of penetrating arteries due to application of Gamma Knife radiation triggered a disruption of the cerebellorubrothalamic circuitry, and thereby tremor [6].…”

“…The first one is by Chiou et al [6], reporting a 20-year-old patient who developed Holmes tremor after receiving Gamma Knife treatment for arteriovenous malformation. It was strongly suspected that, in this case, focal edema or infarction caused by obliteration of penetrating arteries due to application of Gamma Knife radiation triggered a disruption of the cerebellorubrothalamic circuitry, and thereby tremor [6]. A similar cause was possible in our patient given the location of the lesion and the known association between basal ganglia dysfunction and dystonia.…”

Movement Disorders Associated With Radiotherapy and Surgical Procedures

“…Post radiotherapy tremor can occur either as a palatal tremor or Holmes tremor, following radiotherapy directed toward the pons and midbrain via gamma knife radiosurgery (GKRS) for AVMs 21,22 or after whole-brain irradiation. 23 In contrast to other post radiotherapy movement disorders, post radiotherapy tremor, either palatal or Holmes, has a relatively shorter range of latency (2 weeks-3.5 months).…”

“…Post radiotherapy tremor can occur either as a palatal tremor or Holmes tremor, following radiotherapy directed toward the pons and midbrain via gamma knife radiosurgery (GKRS) for AVMs [ 21 , 22 ] or after whole-brain irradiation [ 23 ].…”

Delayed Perilesional Ischemic Stroke after Gamma-knife Radiosurgery for Unruptured Deep Arteriovenous Malformation: Two Case Reports of Radiation-induced Small Artery Injury as Possible Cause

“…This is because surgical removal of a deep seated AVM is especially difficult, producing high mortality and morbidity rates. 1) 2) 6) 8) Consequently, gamma-knife radiosurgery (GKRS) has been employed for patients with a deep seated AVM. Although rare, radiation-induced vasculopathy is one of the most serious complications after GKRS.…”