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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
PubMed

Insights

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.
Keywords:
Brain abscessdeep brain stimulationdopamine agonistsimmunocompromised hosttremor

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