Abstract Details

Title Tremor Associated with a Frontal and Parietal Cortical Infarct

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P1 - Poster Session 1 (8:00 AM-9:00 AM)

Poster/Presentation
Number 13-003

Objective NA

Background Movement disorders can present as the first sign or delayed complication of ischemic stroke. Tremor remains one of the least common post-stroke movement disorders, typically a consequence of lacunar infarcts in the caudate nucleus, thalamus, or midbrain. Cortical tremors have rarely been reported with infarcts involving the frontal and/ or parietal cortex.

Design/Methods NA

Results

An 87-year-old woman with a past medical history of atrial fibrillation presented with transient right upper extremity numbness. Magnetic resonance imaging of the brain revealed an acute ischemic stroke in the left parietal cortex. A cardioembolic source was suspected and anticoagulation was initiated. The patient was discharged home with no residual neurologic deficits.

Three days later, the patient developed a new-onset tremor in the right hand. Neurologic examination revealed a high-frequency, low-amplitude, fine hand tremor associated with occasional involuntary muscle jerks. Coordination examination revealed finger to nose ataxia on the right. Imaging of the brain revealed an acute ischemic stroke in the left frontal and parietal cortices despite compliance with anticoagulation. Vessel imaging of the head and neck revealed a ruptured plaque with associated thrombus in the proximal left internal carotid artery, which was believed to be the source of multiple emboli in the left hemisphere. The tremor gradually improved with complete resolution within a few days after discharge.

Conclusions Tremor due to cortical ischemic stroke is a rare variant of cortical reflex myoclonus. The tremor is likely due to augmented cortical excitability caused by ischemia of the sensorimotor cortex. In our case, ischemia of the frontal and parietal cortices is the most likely cause of the transient tremor. New-onset tremor can be the first sign of an ischemic stroke, and prompt recognition is critical for timely diagnosis and management.

Authors/Disclosures
Sayyeda Zahra, MD (Lehigh Valley Health Network) PRESENTER	Dr. Zahra has nothing to disclose.
Cleo Zarina A. Reyes, MD	Dr. Reyes has nothing to disclose.
Erafat Rehim, MD (LVHN)	Dr. Rehim has nothing to disclose.
Tsneem Mbydeen, MBBS (LVHN)	Dr. Mbydeen has nothing to disclose.
Hussam A. Yacoub, DO (The Lehigh Valley Health Network)	Dr. Yacoub has nothing to disclose.

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