Tremor Secondary to a Thalamic Glioma: A Case Report

Tremor is the most prevalent movement disorder. While the exact pathophysiology remains to be elucidated, the importance of the thalamus in tremor circuitry is well recognized. Thalamic lesions from demyelination, trauma, ischemia, or neoplasm rarely cause isolated tremor. We report the case of a patient presenting with a tremor secondary to a thalamic grade II astrocytoma that improved with treatment.

A 50-yr-old male presented with a 1-yr history of right-hand tremor. The presence of long tract signs prompted imaging that revealed a lesion within the left thalamus. Stereotactic biopsy revealed a World Health Organization grade II astrocytoma. Prior to biopsy, the patient's tremor was graded using the Clinical Rating Scale for Tremor. Immediately postoperatively the patient remained at his neurological baseline without improvement in his tremor. Subsequent fractionated radiotherapy with concomitant temozolomide followed by adjuvant temozolomide led to radiographic response as well as clinical improvement. The patient reported less tremor, which was confirmed objectively with improved Clinical Rating Scale for Tremor scores at 6 and 12 mo postoperatively.

This case of a thalamic glioma presenting with isolated contralateral tremor highlights the role of the thalamus in the development of tremor. Moreover, this particular case contrasts with other published reports on the lack of additional symptoms and tremor response to chemoradiation.