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).
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