English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

45 Dear Editor, A-70-year-old female was admitted to our clinic due to rightsided unilateral tremor that was prominent in the upper extremity, which had significantly progressed over the last five years such that she had difficulty in performing fine motor skills and many self-care activities. Upon history-taking, it was learnt that the tremor had started with a short interval (approximately one month) following a hemi-cerebellar resection surgery for meningioma, 20 years ago. The patient and her relatives stated a continuous progression of tremor over the last 20 years. On neurologic examination, rightsided unilateral rest tremor of the upper extremity was apparent that was more prominent during maintenance of posture and intention, which was compatible with Holmes’ tremor (Video 1). Cerebellar examination showed right-sided dysdiadochokinesia and truncal ataxia; other neurologic examinations including motor and sensory functions were within normal limits. Cranial magnetic resonance imaging showed encephalomalacia in the right cerebellum (Figure 1). Levodopa/benserazide 3x100/25 mg and pramipexole 3 mg were tried separately, which failed to provide any improvement. However, valproic acid 2x500 mg treatment provided a moderate improvement in the severity of all subtypes of the tremor (resting, postural, and intention) (Video 2). The mechanisms underlying Holmes’ tremor have been tried to be explained in the setting of disturbances of both the nigrostriatal dopaminergic pathway and cerebello-thalamic systems (1). However, the pathophysiologic basis of this phenomenon has not

Holmes’ Tremor due to Hemi-cerebellarEncephalomalacia and Improvement with Valproic Acid Therapy