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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.
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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.
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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.
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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.
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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.
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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

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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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  • 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
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