Contralateral hemi-parkinsonism and atypical tremor after stroke (a case report)

Extrapyraramidal parkinsonian-like syndromes have been observed as manifestations of different central nervous system lesions. A 45-year-old-man gradually developed tremor and slowing of movements 2 years after a stroke. Neurological examination revealed slight hemiparesis, muscle rigidity and bradykinesia in the left limbs. A tendency for hypomimia and impaired postural reflexes were found. There were resting, more pronounced postural and kinetic and most pronounced intentional tremors involving the left limbs. On electromyographic examination the static tremor was of 4Hz frequency, while the postural, kinetic and intention tremors were of 7Hz frequency. All tremors were with alternating activity in antagonist muscles. In conclusion our findings confirm the common anatomical basis of parkinsonism and essential like tremor. Both can appear after disruption of the pathways within and adjacent to the basal ganglia.