Tremor and dystonia after penetrating diencephalic-mesencephalic trauma

Isolated post-traumatic basal ganglia or brainstem lesions secondary to direct injury resulting in movement disorders, such as tremor or dystonia, are extremely rare. We report an unusual case with a 4-5 Hz rest and postural tremor and focal action-induced dystonia of the left arm. The movement disorder developed within 2 years of the patient sustaining a right-sided mesencephalic-diencephalic lesion due to a penetrating thrust injury with a screwdriver. Magnetic resonance imaging demonstrated involvement of the cerebral peduncle, the substantia nigra, the subthalamic region and the thalamus.