Midbrain
tremor is a resting, postural, action and intentional
tremor of the upper extremity. Partial response to pharmacological agents makes the treatment of this
tremor difficult. We report, herein, three cases of patients with midbrain
tremors involving their midbrain and thalamic area in ischemic and
hemorrhagic strokes. In the first case, the patient presented with a midbrain
tremor of the right upper extremity involving left midbrain and thalamic area. After MRI examination, he was placed on
benztropine,
amantadine,
pramipexole and eventually
levodopa for treatment, all of which were unsuccessful in improving his
tremor. In the second case, the patient presented with a midbrain
tremor of the right upper extremity after an
hemorrhagic stroke. After viewing CT and MRI scans, the patient was placed on
amantadine,
pramipexole and eventually
levodopa, all of which made no contributions to his
tremor. The patient in the third case presented with a blunt
trauma to the head which led to the development of a midbrain
tremor of his left arm. CT and MRI scans showed abnormalities in the right side of the midbrain and pons. He was initially started on
amantadine, with no improvement of his
tremor. However, he was eventually placed on
trihexyphenidyl which contributed to a 70% improvement in his
tremor. In the event of midbrain
tremor, treatment should be assessed on a case by case basis, and all options should be considered after a risk-benefit assessment.