Disappearance of bilateral essential tremor after acute stroke: A case report and literature review

Rationale: Acute ischemic stroke is an important cause of in worldwide mortality and morbidity. nevertheless, in certain instances of concomitant idiopathic tremor, stroke lesions may have a therapeutic effect in alleviating the symptoms of idiopathic tremor. Limited reports exist on the improvement of essential tremor (ET) following a stroke. This research presents a case of symptom improvement in ET following acute stroke thrombolysis in the right centrum semiovale of a patient. Patient concerns: The patient is a retired 75-year-old male who is right-handed. He was hospitalized on January 1, 2021, due to limited movement in his left limbs and difficulties with speech. The patient has experienced a bilateral tremor in the upper limbs for 30 years, with exacerbation on the left side. The left finger-nose test lacked stability and precision. Diagnoses: The cranial computed tomography revealed scattered lacunar infarctions in the brain. The magnetic resonance imaging revealed many lacunar lesions in the bilateral basal ganglia and the centrum semiovale. A fresh lesion was seen in the right centrum semiovale. Outcomes: In the treatment of cerebral infarction, patients did not receive treatment and intervention for tremor symptoms. However, the patient also showed significant improvement in tremor in both upper extremities after the symptoms of acute cerebral infarction subsided, and the finger–nose test was consistent and precise on both sides. Fahn-Tolosa-Marin tremor rating scale 7 points. Lessons: The three-dimensional T1-weighted imaging, diffusion weighted imaging and diffusion tensor imaging sequences of magnetic resonance imaging images were analyzed, and BrainVoyager was used to visualize the location relationship between the infarct focus, thalamus and related fiber conduction tracts. It was inferred that the descending corticospinal tract and the 2 ascending conduction tracts from thalamus to cerebral cortex formed a complete neural circuit. The location of the infarct intersects the above conduction tract and thus interferes with the oscillatory network within it. Therefore, it is possible to break the oscillation network of ET by interfering with a certain node, which can provide more ideas for the treatment of ET in the future.