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Holmes’ tremor (also known as rubral or midbrain tremor) is a rare movement disorder characterized by a low frequency tremor of the upper extremity at rest and upon voluntary movement. This report presents the case of a patient who developed a tremor of her right arm, with hemiparesis and ataxia as a result of systemic and cerebral toxoplasmosis in association with AIDS. MRI brain imaging showed a lesion in the contralateral red nucleus in the rostral midbrain, consistent with toxoplasmosis, and confirming the diagnosis of a Holmes’ tremor. The patient responded well, symptomatically, to botulinum toxin (Botox) injections. This case illustrates the importance of neuroimaging in diagnosis of tremor disorders. |
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