Article Text

Reversible Holmes' tremor due to spontaneous intracranial hypotension
  1. Rajesh Shankar Iyer1,
  2. Pandurang Wattamwar2,
  3. Bejoy Thomas3
  1. 1Department of Neurology, KG Hospital, Coimbatore, Tamil Nadu, India
  2. 2Department of Neurology, United CIIGMA Hospitals, Aurangabad, Maharashtra, India
  3. 3Department of Imaging Sciences and Interventional R, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
  1. Correspondence to Dr Rajesh Shankar Iyer, dr_rsh{at}


Holmes’ tremor is a low-frequency hand tremor and has varying amplitude at different phases of motion. It is usually unilateral and does not respond satisfactorily to drugs and thus considered irreversible. Structural lesions in the thalamus and brainstem or cerebellum are usually responsible for Holmes’ tremor. We present a 23-year-old woman who presented with unilateral Holmes’ tremor. She also had hypersomnolence and headache in the sitting posture. Her brain imaging showed brain sagging and deep brain swelling due to spontaneous intracranial hypotension (SIH). She was managed conservatively and had a total clinical and radiological recovery. The brain sagging with the consequent distortion of the midbrain and diencephalon was responsible for this clinical presentation. SIH may be considered as one of the reversible causes of Holmes’ tremor.

  • movement disorders (other than parkinsons)
  • brain stem / cerebellum
  • neuroimaging

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  • Contributors RSI conceived the idea and designed the paper. PW contributed in the discussion and final draft of the paper. BT contributed in discussion of imaging studies and clinical correlation.

  • Competing interests None declared.

  • Patient consent Obtained from guardian.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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