Delayed unilateral post-traumatic tremor: localization studies using single-proton computed tomographic and magnetic...

We present the case of a 46-year-old former U.S. Marine who developed unilateral dystonic tremor responsive to anticholinergic medications 13 years after contralateral, combat-induced head trauma. Although conventional neuroimaging techniques showed normal brain anatomy, single-proton computed tomographic scans demonstrated hypometabolism ipsilateral to the area of old trauma. Proton echoplanar spectral imaging demonstrated decreased signal in this same area on creatine imaging, which normalized on anticholinergic medication. Choline imaging on medication showed a signal void in the clinically suspected basal ganglia-thalamus region. We believe that these results indirectly suggest a trans-synaptic origin of the patient's movement disorder.