[Homes' tremor is rare kind of tremor caused by lesion of rubro-spinal tract]

Abstract

The irregular rhythm, presence at rest and acceleration during posture and active movements, low frequency and focal signs are its main features. A case of 49 years old male with tremor of left arm lasting five years is reported. The patient has been suffering from rheumatoid arthritis from 1987.8 years ago a chronic lymphoblasic leukemia was revealed. In upper left arm irregular rest, postural and kinetic tremor occurs, with increasing amplitude and frequency 3.5 Hz. Physical examination revealed pyramidal syndrome and deliberative symptoms. MRI showed vasculitis-like subcortical changes and leukoarajosis-like signs. Neuropsychological examination indicates slight impairment of cognitive functions. Treatment with benzodiazepins and L-dopa was ineffective. Described above symptoms fulfill Holmes' tremor criteria. Only few studies confirmed correlation between tremor and presence of autoimmune diseases. Our case is the first study describing Holmes' tremor, which occurred during rheumatoid arthritis or chronic lymphoblastic leukemia.