Suppression of primary writing tremor by lisuride. A case report

We report a patient who exhibited severe tremor in the right hand and fingers primarily while writing. Tremor showed no improvement with various medications, including proplanolol and clonazepam. Writing and drawing difficulties of the patient gradually decreased from the third week of lisuride treatment, and his tremor was totally abolished at the end of the eighth week. When he interrupted lisuride treatment for a few days, his tremor increased again over the next few days. He made the second full recovery after new treatment with lisuride. Regarding its response to a dopaminergic agonist, it may be suggested that primary writing tremor might arise in basal ganglia or related structures in the brain.     

Treatment of primary writing tremor with botulinum toxin type a injections: report of a case series

Primary writing tremor is a rare motor disorder in which tremor occurs primarily during writing and is not accompanied by other neurological symptoms and/or signs. Its etiopathogenesis is unknown, and treatment approaches remain largely empirical. Based on the effectiveness of botulinum toxin injections in writing dysfunction, we effectively used botulinum toxin type A for the treatment of primary writing tremor in a series of patients seen over a period of 5 years. Of the 5 patients, four received injections and reported significant and sustained treatment benefit for a period of at least 1 year. One patient declined botulinum toxin injections and responded moderately when treated with trihexyphenidyl.     

Transient improvement of essential tremor during electroconvulsive therapy

We present a patient who demonstrated transient yet significant improvement of essential tremor (ET) during electroconvulsive therapy. To our knowledge, this is the first such report. The improvement lasted during the course of electroconvulsive therapy and was of a similar magnitude to that which she had experienced on a first-line medication for ET. We discuss the potential pathophysiological implications of this observation in light of recent histopathologic findings in patients with ET.     

Rapid improvement of callosal edema by thiamine administration in Marchiafava-Bignami disease: a case report]

Marchiafava-Bignami disease (MBD) associated with chronic alcoholism is a fatal disorder characterized by demyelination of the corpus callosum. A 62-year-old Japanese man, a heavy drinker for his last over 10 years, was admitted to our hospital because of acute onset of speech disturbance. The first MR images showed abnormal signal intensity of the corpus callosum, which was a typical finding of MBD, but no signal abnormality on diffusion-weighted images. At three days after large doses of thiamine administration, MR studies revealed the disappearance of callosal high signal intensity. His symptom gradually improved, the pathogenesis and therapy of MBD were discussed.     

Rubral tremor of Holmes, rare case of pathological tremor: case report

The authors present a very rare case of Holmes tremor (previously known as rubral or midbrain tremor). In all described till now cases the tremor was due to a known and revealed in laboratory or neuroimaging cause. We present an unusual case of a 42-year old woman with unilateral tremor of right extremities (mostly proximal part of upper extremity) which started abruptly 3 years ago. She had no suffer any serious disease before the onset of symptoms and her family history was also negative. The tremor was present at rest but accelerated during specific postures and active movements. The laboratory tests including: copper and ceruloplasmin concentrations, blood analysis for acanthocytes, evoked potentials, EEG, CT, MRI, MRA and SPECT did not reveal any significant changes. Treatment attempts with neuroleptics, clonazepam, L-dopa, valproic acid, biperiden were almost completely ineffective except local injections of botulinum toxin (Botox, Allergan, 150 U) into the muscles of right arm girdle which moderately alleviated tremor. We did not find any underlying pathology as a cause of tremor, clinically the same as symptomatic cases described in literature. We suggest the possibility of idiopathic origin of tremor in our case, although a very small size of lesion (f.i. ischaemic) could be undetectable in the described tests.     

Holmes' tremor and neuroparacoccidioidomycosis: a case report.

We report on a case of neuroparacoccidioidomycosis that presented with a midbrain mass lesion associated with Holmes' tremor. The difficulties of pharmacological treatment of such tremor are emphasized.     

Primary writing tremor: report of a case successfully treated with botulinum toxin A injections and discussion of underlying mechanism.

Primary writing tremor (PWT) is a rare motor disorder of unknown etiology, where tremor is elicited primarily or exclusively with writing. We describe a patient with PWT, present a video before and after successful treatment with botulinum toxin type A injections, and discuss a possible underlying dystonic mechanism.     

Transient epileptic amnesia: a neurosurgical case report

One memory disorder that is potentially treatable with antiepileptic drugs is transient epileptic amnesia (TEA). Working diagnostic consensus criteria for TEA include: (1) a history of recurrent witnessed episodes of transient amnesia; (2) confirmation by a reliable witness that cognitive functions other than memory are intact during typical episodes; and (3) evidence for a diagnosis of epilepsy. We describe a case with both complex partial seizures and episodes of TEA. This is the first reported case of a neurosurgical intervention for symptoms resembling those described in refractory TEA. Video/EEG, 3-T MRI, neuropathology, and neurological as well as neuropsychological findings are presented with postsurgical clinical outcome. The patient underwent right anterior amygdalohippocampectomy for symptoms resembling refractory TEA with additional complex partial seizures at our epilepsy surgical center. She remained seizure free at the 15-month follow-up, and memory complaints remitted. This case report illustrates one memory disorder, transient epileptic amnesia, that is potentially treatable with antiepileptic drugs or surgery.     

Transient exacerbation of frozen gait by a border zone cerebellar infarction in a patient with vascular parkinsonism: a case report]

We report an 80-year-old man with vascular parkinsonism whose frozen gait was transiently worsened by a cerebellar infarction. Four months before his first admission, he was diagnosed with gastric and esophageal cancer at another hospital, where he had a partial remission by radiotherapy. Two weeks before admission, left hemiparesis due to a lacunar infarction appeared, and he was transferred to our hospital for rehabilitation. Upon admission, he had minimum left hemiparesis and mild frozen gait caused by multiple cerebral infarctions. His condition was improved by physical therapy, and he became ambulatory. Two months later, however, he suddenly became unable to walk and was readmitted. Neurological examination revealed severe frozen gait without other changes. An MRI scan revealed a small new infarction in the left cerebellum between the lateral and the medial superior cerebellar artery area. By supportive therapy, his gait disturbance was gradually resolved except for a slightly short step. Frozen gait is considered a sign of dysfunction of the frontal lobe or nigro-striate system. It is regarded as a component of vascular parkinsonism. Some vascular parkinsonism patients are known to show wide-based gait and some cerebellar signs. It was presumed that our patient's frozen gait might have been exacerbated by impaired equilibrium resulting from the border zone cerebellar infarction.     

Distal ulnar neuropathy as a cause of finger tremor: a case report

A secretary/typist developed work-related pain along the hypothenar aspect of the dominant hand. This was later followed by involuntary, finally continuous tremorous movements of the 4th and 5th fingers. Electromyographic abnormalities were limited to myokymia of 3rd and 4th interossei muscles. Surgical decompression of Guyon's canal with removal of the pisiform bone resulted in a complete cure.     

Orthostatic tremor: report of a case and review of the literature

Orthostatic tremor is a rare movement disorder characterized by tremulousness of the lower limbs on standing that disappears on walking, sitting or on lying down and a distinctive electromyographic burst of 14 to 16 Hz. On inspection, fine ripples can sometimes be seen over the quadriceps on standing. The tremor has a tendency to reappear even in the supine posture if the lower limb muscles are put to an isometric contraction state, indicating thereby that in spite of the fact that the tremor occurs on standing, it is essentially 'orthostasis independent' and the central factor is the contraction of the muscles. As a matter of fact, the tremor is abolished if the subject is suspended by harness, thus relieving him of muscle contraction. Doubts are being cast whether it is a variant of essential tremor since a number of families are being reported to be suffering from this disease as well. Positron emission tomography reveals hyperactivity of cerebellum in orthostatic tremor as it shows in essential tremor, therefore lending credence to such a hypothesis. However, lack of response to alcohol, propranolol and primidone in orthostatic tremor stands out as a serious challenge to such a view. Lack of positive family history, synchrony of contracting group of muscles and negative 'resetting' of the tremor by increasing peripheral load-phenomena consistently observed in orthostatic tremor and not in essential tremor, are other features that often help to distinguish between the two conditions. We report a case of orthostatic tremor that presented with the classical clinical and electromyographic features. Relevant literature in this regard is also being reviewed.     

Transient Epileptic Amnesia: a case report and a reappraisal

Transient Epileptic Amnesia is a late-onset form of temporal lobe epilepsy characterized by recurrent attacks of transient retrograde and anterograde amnesia usually lasting less than one hour and beginning in late-middle to old age. Attacks commonly occur on waking, a potentially helpful diagnostic clue. The amnesic attacks may be associated with persistent memory complaints. The diagnosis is made on the basis of the clinical history, wake or sleep -?deprived EEG (often repeated) and/or a clear?- cut response to anticonvulsivant therapy. The pathophysiology remains poorly understood. It is uncertain whether recurrent episodes of amnesia represent ictal or post-ictal phenomena.     

Successful treatment of tremor in Wilson's disease by thalamotomy: A case report.

Little information is available on the surgical treatment of movement disorders in Wilson's disease. We report a successful outcome of left-sided stereotactic thalamotomy in a 30-year-old man with Wilson's disease, who had severe postural-kinetic tremor of both hands. The improvement was bilateral. Our case illustrates that stereotactic thalamotomy may be considered as an option in treating severe tremor in selected patients of Wilson's disease and merit further trials.     

Speech-related tremor of lips: a focal task-specific tremor]

We report a 66-year-old Japanese woman in whom tremor of lips appeared during speech. Her past and family histories were unremarkable. On neurological examination, there was no abnormal finding except the lip tremor. Results of laboratory findings were all within normal levels. Her MRI and EEG were normal. Surface EMG studies revealed that regular grouped discharges at a frequency of about 4-5 Hz appeared in the orbicularis oris muscle only during voluntary speaking. The tremor was not observed under conditions of a purposeless phonation or a vocalization of a simple word, suggesting that the tremor was not a vocal tremor but a task-specific tremor related to speaking. Administration of a beta-blocker and consumption of small amount of alcohol could effectively improve the tremor, possibly suggesting that this type of tremor might be a clinical variant of essential tremor.     

Transient focal abnormalities of MRI and angiographic neuroimaging in status epilepticus: case report]

We reported transient changes in computed tomography (CT), angiography and magnetic resonance imaging (MRI) scans in a patient with status epilepticus, referred to us with a tentative diagnosis of neoplasma based on CT, MRI and angiographic findings, MRI showed increased signal intensity, and CT showed decreased left hemisphere attenuation without enhancement. Two months later, resolution of these radiological and clinical abnormalities had been attained. The transient CT and MRI changes probably represented focal cerebral edema, developing during focal status epilepticus.     

Velopharyngeal palsy: a case report]

Here we present a case of velopharyngeal palsy. An 18-year-old man had hyperemia in his left conjunctivum. One or two weeks later he experienced nasal speech and difficulty in swallowing. General physical examination was normal. The only abnormal neurological finding was palato-pharyngeal paralysis on the right side. MRI of the head and neck had no abnormalities. Acute and convalescent sera showed no rise in viral antibody titer. CSF examination was normal except for the increased IgG% and IgG.albumin index. Treatment consisted of glycerol and steroid, and his symptom improved within two or three weeks. We think immunological mechanism is important because CSF examination showed increased IgG% and IgG.albumin index in our case. Acquired and isolated velopharyngeal palsy is uncommon. Only 26 cases have been reported so far. This is the first case in Japan. The disease has some characteristics. This occurs in childhood and adolescence. Onset is sudden, consisting in rhinolalia and dysphagia. On examination there is asymmetry of the pharynx and deviation of the uvula contralateral to the affected side. There is no other neurological abnormalities. Complete spontaneous recovery is usual. In some cases viral infection is the cause, but in most cases the cause is unknown. In contrast, the disease with both acquired velopharyngeal palsy and vocal cord palsy is relatively common. This occurs in the middle aged or elderly people. In addition to dysphagia and hoarse voice, this disease often accompanies neurological abnormalities such as other cranial nerve palsy and meningitis, fever, and pain in the pharyngeal region. In most cases viral infection is the cause.     

Transient topographical amnesia: A case report

We describe the case of a 56 year old female, with a history of migraine since adolescence, who experienced two episodes of transient topographical disorientation in the absence of intellectual deterioration or evident focal cerebral lesions.

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Sommario Viene descritto il caso di una paziente di 56 anni, con storia di emicrania fin dall'adolescenza, caratterizzato da due episodi di disorientamento topografico transitorio, in assenza di deterioramento mentale e di evidenti lesioni cerebrali focali.