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Holmes Tremor Following Midbrain Abscess in an Immunocompromised Patient: A Case Report.
Anas Aminin W M Izzuddin1, Abdul Hanif Khan Yusof Khan1, Laila Mastura Ahmad Apandi2
1Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia.
Neurology India
|March 12, 2026
Summary
This case study details Holmes tremor (HT) in a patient with retroviral disease and a midbrain abscess. It emphasizes recognizing HT as a potential neurological complication of midbrain infections.
Area of Science:
- Neurology
- Infectious Diseases
Background:
- Holmes tremor (HT) is a rare neurological disorder typically resulting from midbrain lesions.
- Midbrain abscesses, though uncommon, can lead to significant neurological deficits.
Purpose of the Study:
- To report a case of Holmes tremor (HT) in a patient with retroviral disease and a midbrain abscess.
- To highlight the association between midbrain abscesses and the development of HT.
- To underscore the importance of recognizing HT in patients with midbrain lesions.
Main Methods:
- Case report of a patient presenting with fever and cranial nerve palsy.
- Brain imaging (MRI and CT) to identify a midbrain lesion.
- Laboratory investigations for infectious etiologies, including toxoplasmosis serology.
- Clinical assessment of tremor characteristics consistent with HT.
Main Results:
- A midbrain abscess secondary to toxoplasmosis was diagnosed in a patient with retroviral disease.
- The patient developed Holmes tremor (HT) following treatment of the abscess.
- Resolution of the brain abscess was observed post-treatment, while HT persisted.
Conclusions:
- Midbrain abscesses can lead to delayed neurological sequelae such as Holmes tremor (HT).
- Prompt recognition and management of midbrain infections are crucial to prevent severe neurological complications.
- Management of HT is complex, with dopaminergic agents and potentially deep brain stimulation for refractory cases.
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