Effective radiofrequency thalamotomy for posttraumatic Holmes tremor: illustrative case

BACKGROUND: Holmes tremor (HT) is a symptomatic tremor that develops weeks to years after stroke, traumatic brain injury, or brain tumor and is characterized by low-frequency, high-amplitude movements at rest, during posture, and with intentional movement. It is thought to result from lesions involving the dopaminergic nigrostriatal system, Guillain-Mollaret triangle, or dentato-rubro-thalamic tract. Because HT is often drug resistant, stereotactic procedures targeting the thalamus are considered. While deep brain stimulation for HT shows long-term efficacy, evidence for radiofrequency thalamotomy remains limited. OBSERVATIONS: An 18-year-old right-handed male developed a coarse tremor of the right hand 1 year after a severe traumatic brain injury at age 16. MRI revealed bilateral cerebellar dentate nucleus hemorrhage, diffuse axonal injury in the left thalamus, and multiple contusions. A diagnosis of posttraumatic HT due to right dentate and left thalamic lesions was made, and ventral intermediate nucleus (Vim) thalamotomy was performed because the tremor was refractory to medication. Tremor improvement was maintained for 18 months postoperatively, with marked enhancement of daily activities and an expansion of the ability to handle various daily tasks. LESSONS: This case illustrates that Vim thalamotomy remains a relevant and effective treatment option for HT. https://thejns.org/doi/10.3171/CASE2675.