Skip to main content
Advertisement
  • Neurology.org
  • Journals
    • Neurology
    • Clinical Practice
    • Genetics
    • Neuroimmunology & Neuroinflammation
  • Specialty Sites
    • COVID-19
    • Practice Current
    • Practice Buzz
    • Without Borders
    • Equity, Diversity and Inclusion
    • Innovations in Care Delivery
  • Collections
    • Topics A-Z
    • Residents & Fellows
    • Infographics
    • Patient Pages
    • Null Hypothesis
    • Translations
  • Podcast
  • CME
  • About
    • About the Journals
    • Contact Us
    • Editorial Board
  • Authors
    • Submit a Manuscript
    • Author Center

Advanced Search

Main menu

  • Neurology.org
  • Journals
    • Neurology
    • Clinical Practice
    • Genetics
    • Neuroimmunology & Neuroinflammation
  • Specialty Sites
    • COVID-19
    • Practice Current
    • Practice Buzz
    • Without Borders
    • Equity, Diversity and Inclusion
    • Innovations in Care Delivery
  • Collections
    • Topics A-Z
    • Residents & Fellows
    • Infographics
    • Patient Pages
    • Null Hypothesis
    • Translations
  • Podcast
  • CME
  • About
    • About the Journals
    • Contact Us
    • Editorial Board
  • Authors
    • Submit a Manuscript
    • Author Center
  • Home
  • Latest Articles
  • Current Issue
  • Past Issues
  • Residents & Fellows

User menu

  • Subscribe
  • My Alerts
  • Log in

Search

  • Advanced search
Neurology
Home
The most widely read and highly cited peer-reviewed neurology journal
  • Subscribe
  • My Alerts
  • Log in
Site Logo
  • Home
  • Latest Articles
  • Current Issue
  • Past Issues
  • Residents & Fellows

Share

October 25, 2016; 87 (17) Resident and Fellow Section

Teaching NeuroImages: Stroke mimicking thalamotomy

Cessation of tremor following ventrolateral thalamic ischemia

Andreas Horn, Laura Kipp, Antonio Meola, Andrea A. Kühn, Christoph Leithner
First published October 24, 2016, DOI: https://doi.org/10.1212/WNL.0000000000003263
Andreas Horn
From the Department of Neurology (A.H., L.K., A.A.K., C.L.), Charité–University Medicine (CVK), Berlin, Germany; Movement Disorders Unit (A.H., A.A.K.), Charité–University Medicine (CVK), Berlin, Germany; Berenson-Allen Center for Noninvasive Brain Stimulation (A.H.), Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Neurosurgery (A.M.), Brigham and Women's Hospital, Boston, MA; NeuroCure–Cluster of Excellence (A.A.K.); Berlin School of Mind and Brain (A.A.K.); and Deutsches Zentrum für Neurodegenerative Erkrankungen (A.A.K.), Berlin, Germany.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Laura Kipp
From the Department of Neurology (A.H., L.K., A.A.K., C.L.), Charité–University Medicine (CVK), Berlin, Germany; Movement Disorders Unit (A.H., A.A.K.), Charité–University Medicine (CVK), Berlin, Germany; Berenson-Allen Center for Noninvasive Brain Stimulation (A.H.), Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Neurosurgery (A.M.), Brigham and Women's Hospital, Boston, MA; NeuroCure–Cluster of Excellence (A.A.K.); Berlin School of Mind and Brain (A.A.K.); and Deutsches Zentrum für Neurodegenerative Erkrankungen (A.A.K.), Berlin, Germany.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Antonio Meola
From the Department of Neurology (A.H., L.K., A.A.K., C.L.), Charité–University Medicine (CVK), Berlin, Germany; Movement Disorders Unit (A.H., A.A.K.), Charité–University Medicine (CVK), Berlin, Germany; Berenson-Allen Center for Noninvasive Brain Stimulation (A.H.), Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Neurosurgery (A.M.), Brigham and Women's Hospital, Boston, MA; NeuroCure–Cluster of Excellence (A.A.K.); Berlin School of Mind and Brain (A.A.K.); and Deutsches Zentrum für Neurodegenerative Erkrankungen (A.A.K.), Berlin, Germany.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Andrea A. Kühn
From the Department of Neurology (A.H., L.K., A.A.K., C.L.), Charité–University Medicine (CVK), Berlin, Germany; Movement Disorders Unit (A.H., A.A.K.), Charité–University Medicine (CVK), Berlin, Germany; Berenson-Allen Center for Noninvasive Brain Stimulation (A.H.), Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Neurosurgery (A.M.), Brigham and Women's Hospital, Boston, MA; NeuroCure–Cluster of Excellence (A.A.K.); Berlin School of Mind and Brain (A.A.K.); and Deutsches Zentrum für Neurodegenerative Erkrankungen (A.A.K.), Berlin, Germany.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Christoph Leithner
From the Department of Neurology (A.H., L.K., A.A.K., C.L.), Charité–University Medicine (CVK), Berlin, Germany; Movement Disorders Unit (A.H., A.A.K.), Charité–University Medicine (CVK), Berlin, Germany; Berenson-Allen Center for Noninvasive Brain Stimulation (A.H.), Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Neurosurgery (A.M.), Brigham and Women's Hospital, Boston, MA; NeuroCure–Cluster of Excellence (A.A.K.); Berlin School of Mind and Brain (A.A.K.); and Deutsches Zentrum für Neurodegenerative Erkrankungen (A.A.K.), Berlin, Germany.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Full PDF
Citation
Teaching NeuroImages: Stroke mimicking thalamotomy
Cessation of tremor following ventrolateral thalamic ischemia
Andreas Horn, Laura Kipp, Antonio Meola, Andrea A. Kühn, Christoph Leithner
Neurology Oct 2016, 87 (17) e208-e209; DOI: 10.1212/WNL.0000000000003263

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Permissions

Make Comment

See Comments

Downloads
580

Share

  • Article
  • Figures & Data
  • Info & Disclosures
Loading

A 76-year-old woman with right-sided tremor-dominant idiopathic Parkinson disease was admitted due to sudden-onset right leg palsy, right hemihypesthesia, and slurred speech but cessation of resting tremor. MRI showed recent infarction in the left thalamus (figure 1). Spatial analysis performed with Lead-DBS software (www.lead-dbs.org) located the lesion to left ventrolateral and ventroposterior nuclei1 (Jones nomenclature), corresponding to the ventrointermediate nucleus (Walker nomenclature), the typical deep brain stimulation target for tremor. The analysis showed that the (nondecussating) dentatothalamic tract,2 which plays a prominent role in tremor pathophysiology, passes through the lesion (figure 2).

Figure 1
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 1 MRI slice views show stroke lesion site and spatial overlap with thalamic nuclei

(A, B) T2-weighted MRI. (C) Diffusion-weighted MRI of the left thalamus with isovolume at intensity value of 280 used to delineate the stroke lesion (figure 2). (D) Atlas structures locate the lesion to ventral lateral/ventral posterior nuclei (Jones nomenclature), which correspond to the ventralis intermedius in Walker nomenclature. For abbreviations, see reference 1.

Figure 2
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 2 3D visualization of the stroke lesion, subcortical nuclei, and dentatothalamic tracts

Visualization of stroke lesion, nuclei defined by the Morel atlas,1 and 2 pathways of the dentatorubrothalamic tract.2 The nondecussating dentatorubrothalamic (nd-DRTT) tract passes through the lesion. The enlarged picture shows the typical location of a DBS electrode with target nucleus ventralis intermedius electrode as placed in patients predominantly suffering from tremor, falling inside the stroke lesion. DN = dentate nucleus. For other abbreviations, see reference 1.

AUTHOR CONTRIBUTIONS

Dr. Horn wrote the manuscript and performed spatial analyses. L. Kipp provided and worked up the clinical case as physician of care together with Dr. Leithner. Dr. Meola provided the atlas of the dentatorubrothalamic tract and revised the manuscript. Prof. Kühn revised the manuscript and provided advice regarding spatial analyses. Dr. Leithner supervised and planed the manuscript, revised the manuscript, and worked up the clinical case as principal physician of care.

STUDY FUNDING

No targeted funding reported.

DISCLOSURE

A. Horn is supported by a grant from the German Research Association (DFG grant KFO247), Stiftung Charité, Berlin Institute of Health, and Prof. Klaus Thiemann Foundation. L. Kipp reports no disclosures relevant to the manuscript. A. Meola is supported by an NIH award (R25CA089017) and reports no conflicts of interest. A. Kühn received honoraria from St Jude Medical and Medtronic, travel grants from Ipsen Pharma and Boston Scientific, consultancies from Boston Scientific, and is supported by a grant from the German Research Association (DFG grant KFO247). C. Leithner reports no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Download teaching slides: Neurology.org

  • © 2016 American Academy of Neurology

REFERENCES

  1. 1.↵
    1. Krauth A,
    2. Blanc R,
    3. Poveda A,
    4. Jeanmonod D,
    5. Morel A,
    6. Székely G
    . A mean three-dimensional atlas of the human thalamus: generation from multiple histological data. Neuroimage 2010;49:2053–2062.
    OpenUrlCrossRefPubMed
  2. 2.↵
    1. Meola A,
    2. Comert A,
    3. Yeh FC,
    4. Sivakanthan S,
    5. Fernandez-Miranda JC
    . The nondecussating pathway of the dentatorubrothalamic tract in humans: human connectome-based tractographic study and microdissection validation. J Neurosurg 2015;124:1406–1412.
    OpenUrlPubMed
View Abstract

Disputes & Debates: Rapid online correspondence

No comments have been published for this article.
Comment

NOTE: All authors' disclosures must be entered and current in our database before comments can be posted. Enter and update disclosures at http://submit.neurology.org. Exception: replies to comments concerning an article you originally authored do not require updated disclosures.

  • Stay timely. Submit only on articles published within 6 months of issue date.
  • Do not be redundant. Read any comments already posted on the article prior to submission.
  • 200 words maximum.
  • 5 references maximum. Reference 1 must be the article on which you are commenting.
  • 5 authors maximum. Exception: replies can include all original authors of the article.
  • Submitted comments are subject to editing and editor review prior to posting.

More guidelines and information on Disputes & Debates

Compose Comment

More information about text formats

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Author Information
NOTE: The first author must also be the corresponding author of the comment.
First or given name, e.g. 'Peter'.
Your last, or family, name, e.g. 'MacMoody'.
Your email address, e.g. higgs-boson@gmail.com
Your role and/or occupation, e.g. 'Orthopedic Surgeon'.
Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.
Publishing Agreement
NOTE: All authors, besides the first/corresponding author, must complete a separate Disputes & Debates Submission Form and provide via email to the editorial office before comments can be posted.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

You May Also be Interested in

Back to top
  • Article
    • AUTHOR CONTRIBUTIONS
    • STUDY FUNDING
    • DISCLOSURE
    • Footnotes
    • REFERENCES
  • Figures & Data
  • Info & Disclosures
Advertisement

Topics Discussed

  • All Movement Disorders
  • All Cerebrovascular disease/Stroke
  • Infarction
  • Surgery/Stimulation
  • Tremor

Alert Me

  • Alert me when eletters are published
Neurology: 96 (16)

Articles

  • Ahead of Print
  • Current Issue
  • Past Issues
  • Popular Articles
  • Translations

About

  • About the Journals
  • Ethics Policies
  • Editors & Editorial Board
  • Contact Us
  • Advertise

Submit

  • Author Center
  • Submit a Manuscript
  • Information for Reviewers
  • AAN Guidelines
  • Permissions

Subscribers

  • Subscribe
  • Activate a Subscription
  • Sign up for eAlerts
  • RSS Feed
Site Logo
  • Visit neurology Template on Facebook
  • Follow neurology Template on Twitter
  • Visit Neurology on YouTube
  • Neurology
  • Neurology: Clinical Practice
  • Neurology: Genetics
  • Neurology: Neuroimmunology & Neuroinflammation
  • AAN.com
  • AANnews
  • Continuum
  • Brain & Life
  • Neurology Today

Wolters Kluwer Logo

Neurology | Print ISSN:0028-3878
Online ISSN:1526-632X

© 2021 American Academy of Neurology

  • Privacy Policy
  • Feedback
  • Advertise