Transient Acute-onset Holmes-like Tremor After Cortical Stroke.
Arianna Scartezzini, Giovanna M Squintani, Cecilia Zivelonghi et al.
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Case in brief
A 68-year-old man experienced acute right-sided facial and upper limb weakness and aphasia due to an isolated precentral cortical ischemic stroke. Within 24 hours, he developed a Holmes-like tremor characterized by rhythmic low-frequency movements of the right hand and forearm, present at rest and during action. Brain MRI confirmed acute ischemic lesions in the left precentral cortex. The tremor resolved within days without recurrence at one-month follow-up.
What made this case unusual
The case is notable for the acute onset of a Holmes-like tremor following isolated precentral cortical lesions, with a distal predominance and spontaneous resolution, which is atypical for this type of tremor.
Diagnostic / clinical pearl
Clinicians should consider the possibility of a Holmes-like tremor following cortical strokes, even in the absence of traditional anatomical involvement.
Why it matters
This case highlights the potential for transient tremors to arise from cortical lesions, suggesting a need to explore network-based mechanisms in movement disorders.