Rubral tremor: clinical features and treatment of three cases

Rubral tremor is characterized by a slow coarse tremor at rest that is exacerbated by postural adjustments and by guided voluntary movements. Some authorities have questioned whether it should be regarded as a distinct clinical entity. We observed three cases of rubral tremor following stroke and studied the movements by videotape recordings. The tremors were very similar in the three cases, and all showed plastic rigidity and dystonic posturing of the affected limbs. Rehabilitation difficulties out of proportion to the motor deficit were present, but all three patients responded favourably to treatment with levodopa-carbidopa. Lesions of the superior cerebellar peduncle, midbrain tegmentum or posterior part of the thalamus may cause this peculiar tremor, and it is probable that lesions of the red nucleus itself are not crucial for its production. The similarity of the clinical features and management problems of these cases suggests that it is valuable to regard rubral tremor as a specific clinical syndrome.