Holmes tremor secondary to brainstem hemorrhage responsive to levodopa: report of 2 cases

Clin Neuropharmacol. 2007 Mar-Apr;30(2):95-100. doi: 10.1097/01.wnf.0000240957.56939.e6.


We report 2 patients who presented a brainstem hemorrhage and who, after 1 and 6 months, respectively, developed a 4-Hz postural and resting tremor consistent with Holmes tremor, which severely interfered with the activities of daily living. In both cases, levodopa dramatically improved the tremor. Pharmacological treatment of this condition is usually disappointing, and surgical procedures are commonly required for severe cases. Our patients, together with 13 others gleaned from the literature, suggest that in cases of Holmes tremor secondary to brainstem hemorrhage, levodopa can be a useful treatment, and it should be tested before considering invasive therapies.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antiparkinson Agents / therapeutic use*
  • Brain Stem / pathology
  • Electromyography / methods
  • Female
  • Humans
  • Intracranial Hemorrhages / complications*
  • Intracranial Hemorrhages / pathology
  • Levodopa / therapeutic use*
  • Magnetic Resonance Imaging / methods
  • Male
  • Middle Aged
  • Review Literature as Topic
  • Time Factors
  • Tremor / drug therapy*
  • Tremor / etiology*


  • Antiparkinson Agents
  • Levodopa